Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities
Johan Herlitz1, Birgitta Wireklintsundström, Angela Bång
1Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. johan.herlitz@gu.se
Insights
Minutes matter for acute myocardial infarction (AMI) and acute ischemic stroke. While AMI patients often suspect their condition more, stroke patients utilize emergency services more, yet AMI treatment is faster. Both require improved early detection and faster treatment initiation.
Area of Science:
- Cardiology
- Neurology
- Emergency Medicine
Background:
- Acute myocardial infarction (AMI) and acute ischemic stroke are life-threatening atherosclerosis complications.
- Early intervention is crucial for limiting organ damage in both conditions.
- Pre-hospital care and patient/provider actions are critical in the acute phase.
Purpose of the Study:
- To compare pre-hospital patient, bystander, and healthcare provider actions in acute myocardial infarction (AMI) and acute ischemic stroke.
- To identify similarities and differences in the acute management of AMI and stroke.
Main Methods:
- A literature search was conducted using PubMed, Embase, and Cochrane Library databases.
Main Results:
- Patients more frequently suspect AMI than stroke, with a gender gap in AMI suspicion.
- Emergency Medical Service (EMS) use is higher for stroke, but hospital admission delay is shorter for AMI.
- Diagnostic tools for EMS are more advanced for AMI; knowledge of early treatment importance impacts delays in both.
Conclusions:
- Despite the 'fast track' concept, treatment initiation is still faster for AMI than stroke.
- Improving early detection and reducing treatment delays are future priorities for both conditions.
- Collaboration between cardiologists, neurologists, and pre- and in-hospital care teams is recommended.
Background:
The two major complications of atherosclerosis are acute myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably. In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count. This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase.
Method:
A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.
Results:
In both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women).With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS) there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably. In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke.
Conclusion:
Both in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between pre-hospital and in-hospital care might be fruitful.
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