Search

Background: Prehospital delay in response to acute myocardial infarction (AMI) symptoms is well documented in the US and Europe, but little is known about it in Asian countries where cardiovascular disease is increasing. Aims: We conducted an observational study of delay times and factors associated with hospital presentation times in 595 patients with AMI from the US, England, Japan and South Korea. Methods: Patients were interviewed about responses to symptoms within 72 h of hospital admission and the medical records were reviewed. Results: The proportions of patients with delay times of 1 h or less were: US - 23%, Korea - 18%, England - 15% and Japan - 8%. In the US and England when others present at symptom onset called an ambulance patients presented two to three times sooner. Independent predictors of presentation within an hour of symptom onset were attribution of symptoms to the heart and not waiting for symptoms to go away. Conclusion: Similar education about the need to seek treatment early in response to AMI symptoms may be applicable in Western and Eastern industrialised populations. © 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Background: Anxiety is common after acute myocardial infarction (AMI) and has the potential to negatively affect physical and psychosocial recovery. There have been no cross-cultural comparisons of anxiety among AMI patients. Aims: To evaluate whether anxiety after AMI differs across five diverse countries and to determine whether an interaction between country, and sociodemographic and clinical variables contributes to variations in reporting anxiety. Methods and Results: A total of 912 individuals with confirmed AMI were enrolled in this prospective, comparative, cross-cultural study. Anxiety was assessed within 72 h of hospital admission using the Brief Symptom Inventory. The mean level of anxiety in the entire sample was 0.62±0.76, which is 44% higher than the normal mean level. Anxiety levels were not significantly different among the countries with the exception that patients in England reported lower levels of anxiety than those in the US (P=0.03). However, this difference disappeared after controlling for sociodemographic variables on which the countries differed. Conclusion: Patients from each country studied experienced high anxiety after AMI. Even though various cultures were represented in this study, culture itself did not account for variations in anxiety after AMI. It appears that anxiety after AMI is a universal phenomenon. © 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Purpose: To compare delay and circumstances of decisions to seek care in patients with acute myocardial infarction (AMI) in the United States (US), England, Australia, South Korea, and Japan. Design: Comparative prospective design. Methods: Patients diagnosed with AMI (N=913) were interviewed within 72 hours of hospital admission for confirmed AMI using the Response to Symptoms Questionnaire. Delay times were calculated from review of emergency room records and patients' interviews. Analysis of variance was used to test differences in delay time among countries. Findings: Median delay ranged from 2.5 hours in England to 6.4 hours in Australia, with the three Pacific Rim countries reporting median delay times > 4 hours. The majority of patients experienced initial symptoms at home (range: 56% in Japan to 73% in the US) with the most common witness being a family member (32% in South Korea to 48% in England). Ambulance use was widely divergent with the highest use in England (85%) and the lowest use in the US (42%). Conclusions: In all countries, median delay was too long to obtain maximum benefit from AMI therapies, particularly thrombolysis. Education and counseling of patients and families to reduce prehospital delay in AMI episodes might be more effective if the various factors influencing patients' first responses to symptoms are considered, as well as differences in health care systems.

Objective: Higher anxiety is linked to poorer outcomes after acute myocardial infarction (AMI), including increased in-hospital reinfarction and potentially life-threatening complications. If clinicians can identify patients at greatest risk for anxiety after AMI, they can institute early treatment. Previous research on the influence of gender on the incidence of anxiety post-AMI reflects inconsistent findings, and differences across cultures have not been studied. Therefore, the purposes of this study were to determine: 1) whether there are gender differences in anxiety in a diverse international sample of AMI patients, and 2) whether there was an interaction between gender and sociodemographic and clinical variables thought to influence anxiety. Methods: In this prospective, comparative study, 912 AMI patients were enrolled from Australia, South Korea, Japan, England, and the United States. Anxiety was assessed, using the Brief Symptom Inventory, within the first 72 hours of admission to the hospital for AMI symptoms. Results: Women had higher anxiety levels than men (0.76 ± 0.90 vs. 0.57 ± 0.70, p =.005), and this pattern of higher anxiety in women was seen in each country studied. Neither sociodemographic nor clinical variables interacted with gender to influence anxiety. Conclusion: Across a variety of cultures, women have higher anxiety than men after AMI and this relationship is independent of age, education level, marital status, or presence of comorbidities or severity of AMI.