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The Physician's Role in Minimizing Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction: Recommendations from the National Heart Attack Alert Program

Kathleen Dracup, RN, DNSc; Angelo A. Alonzo, PhD; James M. Atkins, MD; Nancy M. Bennett, MD, MS; Allan Braslow, PhD; Luther T. Clark, MD; Mickey Eisenberg, MD, PhD; Keith Copelin Ferdinand, MD; Robert Frye, MD; Lee Green, MD, MPH; Martha N. Hill, PhD, RN; J. Ward Kennedy, MD; Eva Kline-Rogers, MS, RN; Debra K. Moser, RN, DNSc; Joseph P. Ornato, MD; Bertram Pitt, MD; Jane D. Scott, ScD, MSN; Harry P. Selker, MD, MSPH; Sharron J. Silva, PhD; William Thies, PhD; W. Douglas Weaver, MD; Nanette K. Wenger, MD; and Suzanne K. White, RN, MN, CNAA
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Working Group on Educational Strategies To Prevent Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction. From the National Heart Attack Alert Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. Note: Patients and health care professionals who need more information about the National Heart Attack Alert Program can contact the National Heart, Lung, and Blood Institute Information Center, PO Box 30105, Bethesda, MD 20824-0105; telephone, 301-251-1222; fax, 301-251-1223; e-mail, nhlbiic@dgsys.com; World Wide Web, http://www.nhlbi.nih.gov/nhlbi/nhlbi.htm; gopher, gopher.nhlbi.nih.gov. Acknowledgments: The authors thank Mary Pat Larsen, MS (King County Department of Emergency Medical Services, Seattle, Washington) for statistical support; Jane Lynn (Severna Park, Maryland) and Alan Jung, DDS (Baltimore, Maryland) for serving as patient representatives; and Patrice Desvigne-Nickens, MD, Denise Simons-Morton, MD, PhD, and George Sopko, MD (National Institutes of Health, Bethesda, Maryland) for scientific review and input. Requests for Reprints: Kathleen Dracup, RN, DNSc, University of California, Los Angeles, School of Nursing, PO Box 951702, Los Angeles, CA 90024. Current Author Addresses: Dr. Dracup: University of California, Los Angeles, School of Nursing, PO Box 951702, Los Angeles, CA 90024.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;126(8):645-651. doi:10.7326/0003-4819-126-8-199704150-00010
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Physicians and other health care professionals play an important role in reducing the delay to treatment in patients who have an evolving acute myocardial infarction. A multidisciplinary working group has been convened by the National Heart Attack Alert Program (which is coordinated by the National Heart, Lung, and Blood Institute of the National Institutes of Health) to address this concern. The working group's recommendations target specific groups of patients: those who are known to have coronary heart disease, atherosclerotic disease of the aorta or peripheral arteries, or cerebrovascular disease. The risk for acute myocardial infarction or death in such patients is five to seven times greater than that in the general population. The working group recommends that these high-risk patients be clearly informed about symptoms that they might have during a coronary occlusion, steps that they should take, the importance of contacting emergency medical services, the need to report to an appropriate facility quickly, treatment options that are available if they present early, and rewards of early treatment in terms of improved quality of life. These instructions should be reviewed frequently and reinforced with appropriate written material, and patients should be encouraged to have a plan and to rehearse it periodically. Because of the important role of the bystander in increasing or decreasing delay to treatment, family members and significant others should be included in all instruction. Finally, physicians' offices and clinics should devise systems to quickly assess patients who telephone or present with symptoms of a possible acute myocardial infarction.





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