Bakgrund: Ischemisk hjärtsjukdom är den ledande dödsorsaken världen över. Det är avgörande att rätt behandling påbörjas i tid, då det annars kan ha skadliga eller fatala konsekvenser för patienten. Den prehospitala verksamheten är central i arbetet för att uppnå behandling inom målsatt tid.  Syfte: Arbetets syfte var att belysa faktorer som fördröjer behandlingstiden prehospitalt för patienter med hjärtinfarkt. Metod: Studiens metod var en allmän litteraturstudie. En strukturerad litteratursökning genomfördes i databaserna CINAHL complete och PubMed under perioden november 2020-april 2021, med sökorden Myocardial infarction, Emergency medical services, Treatment delay och Time-to-treatment. Totalt inkluderades och granskades 17 studier och en integrerad analys genomfördes.  Resultat: Det framkom faktorer under två kategorier: Patientens roll i fördröjningen och Systemets roll i fördröjningen. Under kategorierna indelades faktorerna i fem övergripande teman: Felaktig bedömning av symtom, Skjuta upp beslutet om att söka vård, Patienternas bakgrund, Försenad eller felaktig triagering samt Transport. Patienterna gjorde felaktiga bedömningar av deras symtom, särskild när de upplevde atypiska symtom på hjärtinfarkt. Känslor av skam, ångest eller osäkerhet gjorde att patienterna dröjde med att söka vård. Information om patienternas bakgrund analyserade. Informationen inkluderade demografiska och socioekonomiska faktorer samt informationer om tidigare sjukdomar och riskfaktorer för utvecklingen av hjärtinfarkt, men inget säkert samband kunde visas med fördröjning. Vårdgivarnas hantering och triagering av patienternas symtom kunde orsaka fördröjning.  Slutsats: Insikt i faktorer som fördröjer behandlingstiden prehospitalt kan användas i den fortgående kvalitetsutveckling av vården för patienter med hjärtinfarkt för att minska risken för vårdskador och död. Patientens perspektiv måste tas i beaktning, och läggas till grund för förbättringsarbetet. Resultatet var vid flera tillfällen motstridiga, och ytterligare forskning behövs inom området för att belysa om det finns ett säkert samband. / Background: Ischemic heart disease is the leading cause of death worldwide. It is crucial that proper treatment is initiated in a timely manner, otherwise it might have detrimental consequences for the patient. Emergency medical services is key in the efforts to achieve treatment within the allotted time.  Aim: The aim of this study was to illustrate the factors which cause prehospital delay in treating patients with heart infarction. Method: The method of the study was a general literature review. A structured literaturesearch was conducted in the databases CINAHL complete and PubMed in the timeframe November 2020- April 2021, with the search frases Myocardial infarction, Emergency medical services, Treatment delay and Time-to-treatment. In all, 17 studies were included and reviewed, and an integrated analysis was carried out.  Result: Two categories emerged: The patients’ role in the delay and The systems’ role in thedelay. Under these categories, the factors were classified into five general themes: Inaccurate assessment of symptoms, Delaying the decision too seek care, Patients’ background, Delayed or Inaccurate triage and Transport. The patients assessed their symptoms inaccurately, especially when they experienced atypical symptoms of a heart infarction. Feelings of shame, anxiety or uncertainty delayed patients in their decision to seek care. Information of patients’ backgrounds were analyzed. The information included demographical and socioeconomical factors, as well as information on medical history and risk factor for developing a heart infarction, but no certain connection could be shown to delay. Delay could also be caused by care providers management and triaging of the patient’s symptoms. Conclusion: Understanding the factors of prehospital treatment delay can be utilized in the continuous work to improve the quality of health care for patients with heart infarction to reduce the risk of injury or death. The patient’s perspective must be taken into consideration, in the efforts to improve quality of care. The result was contradictory in several cases, and additional research is needed to illustrate a definite correlation.

Context: Colorectal cancer (CRC) surgical treatment delay (TD) has been associated with mortality and morbidity; however, disparities by TD profiles are unknown. Objectives: This study aimed to identify CRC patient profiles of surgical TD while accounting for differences in sociodemographic, health insurance, and geographic characteristics. Design: We used latent class analysis (LCA) on 2005-2015 Tennessee Cancer Registry data of CRC patients and observed indicators that included sex/gender, age at diagnosis, marital status (single/married/divorced/widowed), race (White/Black/other), health insurance type, and geographic residence (non-Appalachian/Appalachian). Setting: The state of Tennessee in the United States that included both Appalachian and non-Appalachian counties. Participants: Adult (18 years or older) CRC patients (N = 35 412) who were diagnosed and surgically treated for in situ (n = 1286) and malignant CRC (n = 34 126). Main Outcome Measure: The distal outcome of TD was categorized as 30 days or less and more than 30 days from diagnosis to surgical treatment. Results: Our LCA identified a 4-class solution and a 3-class solution for in situ and malignant profiles, respectively. The highest in situ CRC patient risk profile was female, White, aged 75 to 84 years, widowed, and used public health insurance when compared with respective profiles. The highest malignant CRC patient risk profile was male, Black, both single/never married and divorced/separated, resided in non-Appalachian county, and used public health insurance when compared with respective profiles. The highest risk profiles of in situ and malignant patients had a TD likelihood of 19.3% and 29.4%, respectively. Conclusions: While our findings are not meant for diagnostic purposes, we found that Blacks had lower TD with in situ CRC. The opposite was found in the malignant profiles where Blacks had the highest TD. Although TD is not a definitive marker of survival, we observed that non-Appalachian underserved/underrepresented groups were overrepresented in the highest TD profiles. The observed disparities could be indicative of intervenable risk.

Bakgrund: Förekomsten av hjärtinfarkt har i Sverige minskat kraftigt de senaste decennierna och så även andelen personer som avlider som följd. Statistik visar dock att en större andel kvinnor än män avlider. Flera studier visar att många kvinnor avvaktar längre tid än män med att söka vård vilket kan påverka deras överlevnad. Syfte: Att belysa varför många kvinnor avvaktar med att söka vård vid hjärtinfarkt.  Metod: Litteraturöversikt har använts som metod. Databassökningar gjordes i Cinahl Complete och PubMed. Begränsningar var peer reviewed och artiklar skrivna på engelska. Artiklarna publicerades mellan år 2000 - 2022. Tio kvalitativa artiklar valdes ut för analys. Resultat: Resultatet bestod av tre kategorier: Kunskap och symptomtolkning, strategier för att hantera symptom, rädslor och kontrollbehov. Sammanfattning: Sammanfattningsvis har det framkommit att bristande kunskap om symtom vid hjärtinfarkt samt stereotypa uppfattningar av hur och vem en hjärtinfarkt drabbar är de huvudsakliga faktorerna till att kvinnor misstolkar sina symptom på hjärtinfarkt och därmed avvaktar med att söka vård. Vidare så har det framkommit att användandet av olika former av copingstrategier efter att ha feltolkat sina symptom ytterligare förlänger tiden innan kvinnor söker vård. Utifrån studien kan man dra slutsatsen att det i sjuksköterskans preventiva arbete finns ett behov av att arbeta strukturerat och systematiskt med att öka kunskapsnivån hos kvinnor gällande hjärtinfarkt. / Background: The incidence of myocardial infarctions in Sweden has decreased significantly in recent decades and so has the percentage of people who die as a result of myocardial infarctions. Statistics show, however, that more women than men die as a result. Several studies show that many women wait longer than men to seek treatment, which can affect their survival. Aim: To illustrate why many women delay seeking treatment at myocardial infarction.  Method: The chosen methodology is a review of literature. Data collection was undertaken from Cinahl Complete and PubMed. Limitations were peer reviewed articles written in English and published during the period 2000 - 2022. Ten qualitative articles were selected and analysed. Results: The result consisted of the following three categories: Knowledge and interpretation of symptoms, strategies for managing symptoms, fears and need for control. Summary: In summary, it has emerged that lack of knowledge about symptoms of myocardial infarction as well as stereotypical perceptions of how and who it affects are the main factors that lead women to misinterpret symptoms of myocardial infarction and thus delay seeking treatment. Furthermore, it has emerged that the use of various forms of coping strategies after misinterpreting symptoms further extend time to treatment. From the study it can be concluded that, within the nurse´s preventive work, there is a need for increaseing women´s level of knowledge of myocardial infarction.

<p>We evaluated, in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics, admission Troponin T (tnT), ST-segment resolution and admission N-terminal pro-brain natriuretic peptide (NT-proBNP) for early risk stratification as well as time delays and outcome in real life patients according to prehospital or in-hospital thrombolytic treatment. Also, baseline characteristics, treatments and outcome in patients enrolled in the ASSENT-2 trial in Sweden and in patients not enrolled were evaluated. </p><p>TnT (n=881) and NT-proBNP (n=782) on admission and ST-resolution at 60 minutes (n=516) in patients from the ASSENT-2 and ASSENT-PLUS trials were analysed. Elevated levels of NT-proBNP and tnT on admission were both independently related to one-year mortality. However, when adding information on ST-resolution (</≥50%) 60 minutes after initiation of thrombolytic treatment, tnT no longer contributed independently to mortality prediction. High and low risk patients were best identified by a combination of NT-proBNP and ST-resolution at 60 minutes.</p><p>We investigated consecutive STEMI patients included in the RIKS-HIA registry between 2001 and 2004, if they were ambulance transported and had received prehospital (n=1690) or in-hospital (n=3685) thrombolytic treatment. Prehospital diagnosis and thrombolysis reduced the time to thrombolysis by almost one hour, were associated with better left ventricular function and fewer complications and reduced the adjusted one-year mortality by 30% compared with in-hospital thrombolysis. </p><p>Prospective data from the RIKS-HIA registry on STEMI patients treated with thrombolytics were linked to data on trial participants in the ASSENT-2 trial of thrombolytic agents and used for direct comparisons. Patients treated with thrombolytics and not enrolled in a clinical trial at trial hospitals (n=2048) had higher risk characteristics, more early complications and twice as high adjusted one-year mortality compared to those enrolled (n=729). One major reason for the difference in outcome appeared to be the selection of less critically ill patients to the trial.</p>

We evaluated, in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics, admission Troponin T (tnT), ST-segment resolution and admission N-terminal pro-brain natriuretic peptide (NT-proBNP) for early risk stratification as well as time delays and outcome in real life patients according to prehospital or in-hospital thrombolytic treatment. Also, baseline characteristics, treatments and outcome in patients enrolled in the ASSENT-2 trial in Sweden and in patients not enrolled were evaluated. TnT (n=881) and NT-proBNP (n=782) on admission and ST-resolution at 60 minutes (n=516) in patients from the ASSENT-2 and ASSENT-PLUS trials were analysed. Elevated levels of NT-proBNP and tnT on admission were both independently related to one-year mortality. However, when adding information on ST-resolution (&lt;/≥50%) 60 minutes after initiation of thrombolytic treatment, tnT no longer contributed independently to mortality prediction. High and low risk patients were best identified by a combination of NT-proBNP and ST-resolution at 60 minutes. We investigated consecutive STEMI patients included in the RIKS-HIA registry between 2001 and 2004, if they were ambulance transported and had received prehospital (n=1690) or in-hospital (n=3685) thrombolytic treatment. Prehospital diagnosis and thrombolysis reduced the time to thrombolysis by almost one hour, were associated with better left ventricular function and fewer complications and reduced the adjusted one-year mortality by 30% compared with in-hospital thrombolysis. Prospective data from the RIKS-HIA registry on STEMI patients treated with thrombolytics were linked to data on trial participants in the ASSENT-2 trial of thrombolytic agents and used for direct comparisons. Patients treated with thrombolytics and not enrolled in a clinical trial at trial hospitals (n=2048) had higher risk characteristics, more early complications and twice as high adjusted one-year mortality compared to those enrolled (n=729). One major reason for the difference in outcome appeared to be the selection of less critically ill patients to the trial.