Circ Cardiovasc Qual
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Circ Cardiovasc Qual · Nov 2009
Randomized Controlled Trial Multicenter StudyA randomized clinical trial to reduce patient prehospital delay to treatment in acute coronary syndrome.
Delay from onset of acute coronary syndrome (ACS) symptoms to hospital admission continues to be prolonged. To date, community education campaigns on the topic have had disappointing results. Therefore, we conducted a clinical randomized trial to test whether an intervention tailored specifically for patients with ACS and delivered one-on-one would reduce prehospital delay time. ⋯ clinicaltrials.gov. Identifier NCT00734760.
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Circ Cardiovasc Qual · Jan 2009
Multicenter StudyElapsed time in emergency medical services for patients with cardiac complaints: are some patients at greater risk for delay?
In patients with a major cardiac event, the first priority is to minimize time to treatment. For many patients, first contact with the health system is through emergency medical services (EMS). We set out to identify patient-level and neighborhood-level factors that were associated with elapsed time in EMS. ⋯ Compared with otherwise similar men, women have 50% greater odds of being delayed in the EMS setting. The determinants of delay should be a special focus of EMS studies in which time to treatment is a priority.
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Circ Cardiovasc Qual · Jan 2009
Multicenter StudyImpact of age and medical comorbidity on the effectiveness of implantable cardioverter-defibrillators for primary prevention.
Although implantable cardioverter-defibrillators (ICDs) reduce mortality in primary prevention patients with left ventricular systolic dysfunction, recent studies have questioned their overall role in clinical practice, especially in older patients and those with major comorbid conditions. ⋯ Routine use of ICDs in primary prevention patients with left ventricular systolic dysfunction was associated with lower all-cause mortality, even among older patients and those with major comorbid conditions. Although their use needs to be individualized, our findings suggest that these groups should not be routinely excluded from ICD treatment.