Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “heart attack”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Perceived risk of heart attack: a function of gender?

TOPIC: The influence of gender on women's risk beliefs for heart attack. PURPOSE: To inform healthcare providers how women's beliefs and attitudes contribute to treatment-seeking delay in the event of a heart attack, and to establish the importance of risk beliefs in women. SOURCES: Published literature in MEDLINE and CINAHL computerized databases, reference lists of obtained articles. CONCLUSIONS: Women's perceived risk beliefs for heart attack are influenced by the effects of media, cultural, and gender roles and the modeling of bias in health care. There is a need for healthcare providers to change their focus from acting on (etic) a patient to interacting within (emic) the belief systems of their patients to optimize positive outcomes.

Cultural Characteristics↗
PubMed2004

Knowledge of heart attack symptoms in 20 US communities. Results from the Rapid Early Action for Coronary Treatment Community Trial.

BACKGROUND: Effective treatment for patients with acute myocardial infarction is limited by patient delay in seeking care. Inadequate knowledge of heart attack symptoms may prolong delay. An intervention designed to reduce delay was tested in the Rapid Early Action for Coronary Treatment (REACT) Community Trial. In this report, the impact on knowledge of heart attack symptoms is presented. METHODS: Twenty communities were randomized to intervention or comparison status in a matched-pair design. Intervention strategies included community organization, public education, professional education, and patient education. The main outcome measures were based on information regarding knowledge of symptoms collected in a series of four random-digit-dialed telephone surveys. RESULTS: Knowledge of REACT-targeted symptoms increased in intervention communities. No change was observed in comparison communities. The net effect was an increase of 0.44 REACT-targeted symptoms per individual (P<0.001). The intervention effect was greater in ethnic minorities, persons with lower household incomes, and those with family or spouse history of heart attack (P<0.05). CONCLUSIONS: The REACT intervention was modestly successful in increasing the general public's knowledge of the complex constellation of heart attack symptoms. The intervention program was somewhat more effective in reaching disadvantaged subgroups, including ethnic minorities and persons with lower income. Despite these successes, the post-intervention level of knowledge was suboptimal.

Adolescent↗
PubMed1994

A randomised controlled trial of a dietary advice program for relatives of heart attack victims.

OBJECTIVE: To compare two interventions for reducing dietary fat intake in first degree relatives of recent heart attack victims. DESIGN: A randomised controlled trial comparing a low cost mail-out advice program; referral to a general practitioner (GP); and no intervention (control group). PARTICIPANTS: Adult children or siblings, aged less than 70 years, of survivors of definite or suspected heart attack who had been admitted to hospitals in the Lower Hunter Region of New South Wales. MAIN OUTCOME MEASURES: Dietary fat intake (evaluated with a validated short questionnaire) and measurement of blood cholesterol levels at six months. RESULTS: Of the 342 relatives who participated (36% of those invited), 109, 120 and 113, respectively, were randomly assigned to receive a mail-out intervention, advice from their GP or to be part of a control group. The six-month follow-up questionnaire was completed by only 59% of those in the mail-out intervention group compared with 71% of the GP group and 77% of the control group. Younger participants, cigarette smokers and children (compared with siblings) were less likely to return a follow-up questionnaire. The mail-out group showed a statistically significant 20% reduction in self-reported dietary fat intake, but this was not seen in either the GP group or the controls. The low response rate meant the study had insufficient power to detect hypothesised changes in blood cholesterol. CONCLUSION: Because of the poor response rate and possible biases from a differential response to follow-up, we conclude that this low intensity intervention for relatives of people with recent heart attack produces only a modest improvement in reported dietary fat intake. Alternative strategies may be more effective in reducing the risk of heart disease.

Adult↗
PubMed2006

From vulnerable plaque to vulnerable patient--Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report.

Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no government- or healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the "vulnerable patient." These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45-75 years of age and asymptomatic women 55-75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima-media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because <10% of the population who test positive for atherosclerosis will experience a near-term event, additional risk stratification based on reliable markers of disease activity is needed and is expected to further focus the search for the vulnerable patient in the future. All individuals with asymptomatic atherosclerosis should be counseled and treated to prevent progression to overt clinical disease. The aggressiveness of the treatment should be proportional to the level of risk. Individuals with no evidence of subclinical disease may be reassured of the low risk of a future near-term event, yet encouraged to adhere to a healthy lifestyle and maintain appropriate risk factor levels. Early heart attack care education is urged for all individuals with a positive test for atherosclerosis. The SHAPE Task Force reinforces existing guidelines for the screening and treatment of risk factors in younger populations. Cardiovascular healthcare professionals and policymakers are urged to adopt the SHAPE proposal and its attendant cost-effectiveness as a new strategy to contain the epidemic of atherosclerotic cardiovascular disease and the rising cost of therapies associated with this epidemic.

Coronary Artery Disease↗
PubMed2006

Pre-hospital 12-lead electrocardiography programs: a call for implementation by emergency medical services systems providing advanced life support--National Heart Attack Alert Program (NHAAP) Coordinating Committee; National Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health.

Emergency medical services (EMS) providers who administer advanced life support should include diagnostic 12-lead electrocardiography programs as one of their services. Evidence demonstrates that this technology can be readily used by EMS providers to identify patients with ST-segment elevation myocardial infarction (STEMI) before a patient's arrival at a hospital emergency department. Earlier identification of STEMI patients leads to faster artery-opening treatment with fibrinolytic agents, either in the pre-hospital setting or at the hospital. Alternatively, a reperfusion strategy using percutaneous coronary intervention can be facilitated by use of pre-hospital 12-lead electrocardiography (P12ECG). Analysis of the cost of providing this service to the community must include consideration of the demonstrated benefits of more rapid treatment of patients with STEMI and the resulting time savings advantage shown to accompany the use of P12ECG programs.

Angioplasty, Balloon, Coronary↗
PubMed1978

Uses of coronary heart attack registers.

By studying all coronary heart attacks presenting within defined communities it should be possible to avoid the distortions and omissions inherent in hospital-based case series. In practice the technique presents several problems. Measures of frequency and outcome are very sensitive to the diagnostic criteria used. Data of varying quality are mixed and specific attack rates can be calculated only for items for which the census provides a denominator. Patients presenting to different medical services have different outcomes, but probably less because of treatment than because the severity of the attack affects behaviour in it. Despite these problems, some such intelligence system is of value in any comprehensive strategy for coronary heart disease.

Adult↗
PubMed2003

Ask the doctor. A heart attack caused me to develop heart rhythm problems. These made it necessary for me to get an implantable cardioventer/defibrillator (ICD) that can shock my heart back to a normal rhythm. My medical story is a lot like Vice President Dick Cheney's, but my social situation isn't--I don't have anyone to drive me around. My doctor doesn't want me to drive. But depending on friends and family is a major problem, and we don't live near public transportation. Any suggestions?

Explore the source record for details and available documents.

Automobile Driving↗
PubMed2004

Metabolic issues in the Antihypertensive and Lipid-Lowering Heart Attack Trial Study.

Based on the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) Trial, the Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) states that "thiazide-type diuretics should be used as initial therapy for most patients with hypertension." In the ALLHAT study, although there was no difference in the primary outcome for fatal heart attack and nonfatal myocardial infarction between all treatment groups, the manuscript endorses thiazide-type diuretics as first choice, based on their cardioprotective effects and low cost. It is well known that thiazide-type diuretics cause hypokalemia, glucose intolerance, and diabetes, although the ALLHAT study showed a significant 43% to 65% higher risk of new-onset diabetes with chlorthalidone compared with amlodipine (30%) and lisinopril (18%). The investigators justified the fact that the greater incidence of diabetes did not translate into more cardiovascular events. Such a conclusion ignores that the morbidity and mortality from diabetes manifests over decades and not the mere 2- to 6-year time frame examined in the ALLHAT study. It would appear that the strong endorsement of thiazide-type diuretics as first-line therapy by the JNC-7 will lead to a higher incidence of diabetes in these patients.

Antihypertensive Agents↗
PubMed1999

New process results in dramatic improvement for heart attack patients, lower hospital costs.

Ohio hospital reduces admissions for complicated heart attack, thanks to PRO's benchmark project. Cuyahoga Falls General Hospital was surprised when redesigning the way patients are identified as candidates for TPA and other thrombolytic drug therapies resulted in fewer admissions for complicated heart attack. Learn how the revamped system easily can be employed at other hospitals.

Algorithms↗
PubMedDate not supplied

Heart attack: what you don't know can hurt!

Do belching, chills, fatigue, and pressure just above the ribs sound like the symptoms of a heart attack? To most patients, they probably don't. However, research is indicating that a victim's actual symptoms often do not match his or her expectations of what a heart attack should feel like. As a result, many sufferers do not seek medical attention, or they delay it, which can result in permanent damage to the heart muscle or even death. A recent research study indicated that most patients with recent heart attack (74%) interviewed had symptoms different from what they expected. As a result, medical treatment was significantly delayed.

Diagnosis, Differential↗
PubMed1995

Factors determining case fatality in myocardial infarction "who dies in a heart attack"?

OBJECTIVE: To examine the determinants of case fatality in the first major ischaemic heart disease event (heart attack) after screening. METHODS: Prospective study of 7735 middle aged men drawn from general practices in 24 British towns. RESULTS: During 11.5 years follow up there were 743 major ischaemic heart disease events of which 302 (40.6%) were fatal within 28 days of onset. Previous definite myocardial infarction or stroke and age at time of event were most strongly associated with case fatality. In men with no previous myocardial infarction or stroke, after adjustment for a range of risk factors, antihypertensive treatment (odds ratio (OR) = 1.97, P < 0.05), arrhythmia (OR = 1.93, P = 0.06), increased heart rate (OR = 2.03, P = 0.06), and diabetes (OR = 2.61, P = 0.07) were associated with increased case fatality. High levels of physical activity (OR = 0.53, P < 0.05) and moderate drinking (16-42 units/week) (OR = 0.61, P < 0.05) were associated with lower case fatality, although moderate drinking was not associated with a lower incidence of major ischaemic heart disease events. Current smoking, serum total cholesterol, and systolic blood pressure were not significantly associated with case fatality. In men with previous myocardial infarction or stroke, arrhythmia and to a lesser degree antihypertensive treatment, moderate or heavy drinking, and diabetes were associated with higher case fatality. CONCLUSION: These findings suggest that physical activity may be an important modifiable factor influencing the incidence of ischaemic heart disease and the chance of survival in men without a previous heart attack or stroke. Arrhythmia, increased heart rate, diabetes, and treatment for hypertension are also areas of concern.

Adult↗
PubMed1983

Propranolol therapy in patients with acute myocardial infarction: the Beta-Blocker Heart Attack Trial.

The Beta-Blocker Heart Attack Trial was a multicenter, randomized, double-blind, placebo-controlled trial of propranolol therapy in 3837 men and women with acute myocardial infarction. The patients began their treatment 5-21 days after hospital admission (mean 13.8 days). During an average follow-up of 25 months, there were statistically significant reductions in total mortality (26%), cardiovascular mortality (26%), arteriosclerotic heart disease (27%), sudden death (28%) and coronary incidence (definite nonfatal reinfarction plus coronary heart disease mortality) (23%). There was no group difference in incidence of congestive heart failure. Of the many potential side effects that were monitored, broncho-spasm, cold hands and feet, and fatigue occurred more frequently in the propranolol group. Propranolol not only reduced coronary mortality and morbidity, but also was administered with a great degree of safety. Based on these results, its use is recommended for at least 3 years in patients with no contraindications to beta blockade who have had a recent myocardial infarction.

Adult↗
PubMed2003

[Patients' opinions about the reasons for their heart attacks in the context of their health belief models--a preliminary report].

The importance of psychological factors in Myocardial Infarction (MI) is well documented. The aim of the study was to define a relationship between the perception of the reasons for MI and real health activity of the sufferers, in order to prepare an adequate psychological intervention. 30 patients after acute MI hospitalized in the Cardiology Department were included to the study. They were questioned in directed interviews. The modified form of Shalit's Circle was used to infer the model of health activity. Perceived reasons for the heart attack (first in 67% cases) appeared as a manifold area, which was divided into eight categories: stressful situations and occurrences (66.67%), an individual's character (40%), lifestyle (36.67%), connected illnesses 36.67%), genetics (20%), age (13.33%), weather (10%), "spontaneous" heart attack (6.67%). The results indicated exterior attribution of MI (e.g. political and economic crisis, innate predisposition, loss of relatives). Similar tendency in the planning of changes after heart attack was observed. For instance 43.33% patients just said they planed to restrict or give up their previous sickness-promoting behaviour, 33.33% talked laconically about "the increase of caution" or "slowing down" and only 26.67% intended to undertake new forms of activity. These opinions illustrate the general model of health beliefs (in declarations and realization), which seems to be of very limited use (or even disadvantageous) with regard to the future. Moreover, the contemporary clinical conditions are conducive to such model. Modern medical methods of treatment reduce the time spent by patients in hospital, thereby reducing the hospitalization stress. On the other hand it limits or even eliminates the most important part of treatment--the "doctor-patient" relationship. Because of the limited number of subjects a further research is needed to combine the psychological intervention aimed at health behaviour change with the high standard of cardiology treatment those patients are being given now. The psychological program should tackle emotional and social costs of heart attack and strive to change patients' health belief system.

Adaptation, Psychological↗
PubMed1984

Statistical aspects of early termination in the beta-blocker heart attack trial.

The Beta-Blocker Heart Attack Trial was a randomized double blind controlled trial comparing propranolol with placebo in 3837 patients with a recent myocardial infarction. The trial was terminated on recommendation of the Policy and Data Monitoring Board 9 months before the scheduled closing date. The propranolol group, at the time of the decision, had a 26% lower mortality (z = 2.82). Many issues were considered in this decision. These included the magnitude of the overall results; consistency of results across subgroups, clinical centers, and cause of death; and completeness of follow-up. Two basic statistical methods were used in declaring the overall mortality results significant. The first method evaluated the current survival data taking into account the issue of repeated significance testing. The second method evaluated whether the observed trend was so impressive that the conclusion was unlikely to change even if the trial should continue to the scheduled end. These two methods, as well as other considerations led to the recommendation to discontinue the trial.

Adrenergic beta-Antagonists↗
PubMed1995

Do cigarette smokers have unrealistic perceptions of their heart attack, cancer, and stroke risks?

This study examined whether perceived risks of heart attack, cancer, and stroke were higher among smokers than nonsmokers; whether smokers were more likely to underestimate these risks; and the demographic correlates of unrealistic risk estimation among smokers. Two thousand seven hundred eight-five patients from 12 North Carolina family practices completed a questionnaire including a health risk appraisal and questions concerning smoking behavior and perceived risks of heart attack, cancer, and stroke. While most smokers accurately perceived their health risks to be greater than nonsmokers', smokers were also more likely to underestimate their risks. This optimistic distortion of risk was associated with age, gender, and education levels. Smokers may not yet understand the magnitude of health risks posed by smoking. These data suggest the need for renewed attention to perceptions of the health risks of smoking. As long as smokers underestimate their risks, they underestimate the imperative to quit.

Adolescent↗
PubMed2002

Changing the diagnostic criteria for myocardial infarction in patients with a suspected heart attack affects the measurement of 30 day mortality but not long term survival.

OBJECTIVES: To explore the effects of alternative methods of defining myocardial infarction on the numbers and survival patterns of patients identified as having sustained a confirmed myocardial infarct. DESIGN: An inclusive historical cohort of patients admitted with a suspected heart attack. Patients were recoded from raw clinical data (collected at the index admission) to the epidemiological definitions of myocardial infarction used by the Nottingham heart attack register (NHAR), the World Health Organization (MONICA), and the UK heart attack study. SETTING: Single health district. PATIENTS: The NHAR identified all patients admitted in 1992 with suspected myocardial infarction. OUTCOME MEASURES: Survival at 30 days and four year postdischarge. RESULTS: 2739 patients were identified, of whom 90% survived to discharge. Recoding increased the numbers of patients defined as having confirmed myocardial infarction from 26% under the original NHAR classification to 69%, depending on the classification system used. In confirmed myocardial infarction, subsequent 30 day survival from admission varied from 77-86% depending on the classification system; four year survival after discharge was not affected. The distribution of important prognostic variables differed significantly between groups of patients with confirmed myocardial infarction defined by different systems. Patients with suspected but unconfirmed myocardial infarction under all classification systems had a worse postdischarge mortality. CONCLUSIONS: The classification system used had a substantial effect on the numbers of patients identified as having had a myocardial infarct, and on the 30 day survival. There were significant numbers of patients with more atypical presentations, not labelled as myocardial infarction, who did badly following discharge. More research is needed on these patients.

Age Factors↗
PubMed1984

Risk of a coronary heart attack in the normal population and how it might be modified in flyers.

Fatal accident rates in passenger aircraft can be compared directly with coronary heart attack rates in pilots. Although heart attacks are unpredictable in the short term and about 50% of them might cause immediate total incapacitation, rates are such that only a very small percentage of fatal accidents could come from this cause. Risk of attack is highly age- and sex-dependent but pilots should be at lower risk than the general population as half of the events in the latter are recurrences in those with manifest disease which would usually lead to permanent loss of licence . Identification of other markers for coronary heart disease and of coronary risk factors in pilots could lead to a further potential reduction in risk but the effect is small and could be brought about only by grounding a large proportion of existing pilots. Below the age of 50, risk in men is small but above this age special scrutiny may be justified for those involved in single-pilot operations. Better data on the actual risk of developing coronary heart disease in pilots should be provided by setting up a central recording system covering both active aircrew and those who retire for whatever reason.

Accidents, Aviation↗