Patient-reported Symptoms of Acute Coronary Syndrome in Prehospital Cardiac Care

院前心脏护理中患者报告的急性冠状动脉综合征症状

• 批准号: 9903462
• 负责人: Jessica Kathleen Zegre-Hemsey
• 金额: $ 14.17万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9903462
• 关键词: 911 call; Academic Medical Centers; Accident and Emergency department; Accounting; Address; Adult; Adverse event; Age; Ambulances; Award; Cardiac; Cardiac Catheterization Procedures; Caring; Cause of Death; Cessation of life; Chest Pain; Chronic Disease; Clinical; County; Data; Development; Diagnosis; Diagnostic; Diagnostic tests; Discipline of Nursing; Early Diagnosis; Electrocardiogram; Emergency Department evaluation; Emergency Situation; Emergency medical service; Event; Extramural Activities; Faculty; Foundations; Funding; Future; Goals; Health Care Costs; Health Services Research; Heart Diseases; Heart failure; Hospitalization; Hospitals; Individual; Intervention; Investigation; Knowledge; Life; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Monitor; Myocardial Infarction; North Carolina; Oranges; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Pattern; Perception; Persons; Postdoctoral Fellow; Prevalence; Process; Quality of life; Recording of previous events; Reperfusion Therapy; Reporting; Research; Research Methodology; Research Personnel; Sampling; Savings; Scientist; Service delivery model; Severities; Sex Differences; Strategic Planning; Suggestion; Symptoms; Techniques; Time; United States; Universities; Vulnerable Populations; acute coronary syndrome; acute symptom; base; cardiovascular disorder epidemiology; cardiovascular emergency; cardiovascular nursing; care seeking; career development; clinical decision-making; clinical development; clinical practice; design; digital; effective intervention; experience; functional status; improved; improved outcome; innovation; insight; mortality risk; outcome forecast; pain symptom; patient oriented; patient oriented research; patient subsets; pre-doctoral; prevent; professor; programs; rapid diagnosis; recruit; sex; skills; sudden cardiac death; symptom cluster; symptom management; symptom science

PROJECT SUMMARY/ABSTRACT Acute coronary syndrome (ACS) is a potentially life-threatening emergency, and rapid diagnosis and life-saving reperfusion therapies are essential to prevent devastating patient outcomes. Dr. Zègre-Hemsey has extensive clinical experience in the emergency department (ED), where she became committed to improving outcomes for patients with ACS. In her dissertation research, she investigated prehospital electrocardiography (ECG) to improve early diagnosis of ACS, which provided a foundation for the proposed study of patient-reported symptoms and outcomes in her emerging program of emergency cardiac care research. The mentored K23 award is the logical next step to support Dr. Zègre-Hemsey’s long-term goal of becoming an independent cardiovascular nurse scientist, and her outstanding mentoring team will be pivotal to her career development. Dr. Wayne Rosamond (primary) is a professor and preeminent researcher in cardiovascular epidemiology and emergency medical services (EMS) research. He has an extensive history of sustained funding and successful mentorship of numerous junior faculty. Dr. Holli DeVon (co-mentor), is a professor of nursing and expert on symptoms and sex differences in ACS with a strong record of extramural funding and successful mentorship of predoctoral and postdoctoral fellows and junior faculty. In the proposed research, Dr. Zègre-Hemsey will acquire new skills in symptom science and mixed-methods research through coursework, mentoring, and active engagement with established research teams. Using a mixed-methods design, she will investigate how outcomes vary by symptoms in the prehospital period (i.e., symptom onset to ED arrival) in adults transported by ambulance for suspicion of ACS. Specific aims are to: 1) examine the occurrence, severity, and changes in symptoms from prehospital period (Time 1) to ED (Time 2) and evaluate symptom clusters, using the ACS Symptom Checklist; 2) determine if symptoms suggestive of ACS predict adverse patient and clinical outcome; 3a) describe reports of symptoms on 911 call recordings (qualitative aim); and 3b) patterns of symptoms, clusters, and outcomes using mixed-methods techniques (integrated aim). The study will be implemented with a sample recruited from Orange County EMS in North Carolina and transported to the University of North Carolina Hospital, a large academic medical center with an outstanding program in emergency cardiac care. Study results will provide evidence of how symptoms relate to patient and clinical outcomes in patients with suspicious ACS. Results will advance knowledge of symptom science and provide the data to develop future patient-centered interventions in emergency cardiac care. Knowledge from this award will be used for an R-level proposal, to be submitted in Year 3. This patient-oriented study supports NINR’s Strategic Plan to advance symptom science and innovative care delivery models to change chronic illness trajectories. The likely long- term impact of this research is a change in clinical practice resulting in improved survival, functional status, and quality of life for ACS patients in the United States and globally.

项目总结/摘要 急性冠状动脉综合征（ACS）是一种潜在威胁生命的急症，快速诊断和挽救生命 再灌注治疗对于防止破坏性的患者结果至关重要。Zègre-Hemsey博士拥有广泛的 在急诊科（艾德）的临床经验，在那里她成为致力于改善结果， ACS患者在她的论文研究中，她研究了院前心电图（ECG）， 提高ACS的早期诊断，为患者报告的研究提供基础 症状和结果在她的紧急心脏护理研究的新兴计划。K23的设计 该奖项是支持Zègre-Hemsey博士成为独立人士的长期目标的合理下一步 心血管护理科学家，和她的优秀的指导团队将是她的职业发展的关键。 博士韦恩罗萨蒙德（小学）是一位教授和杰出的研究人员在心血管流行病学和 紧急医疗服务（EMS）他有一个广泛的历史，持续的资金和成功的 许多初级教师的指导。Holli德文郡博士（共同导师）是护理学教授， 症状和性别差异在ACS与校外资金和成功的指导， 博士前和博士后研究员和初级教员。在拟议的研究中，Zègre-Hemsey博士将获得 通过课程，指导和积极的症状科学和混合方法研究的新技能 与现有的研究团队合作。使用混合方法设计，她将研究如何 结果因入院前阶段的症状而异（即，症状发作至艾德到达） 被救护车带走了具体目标是：1）检查 从院前（时间1）至艾德（时间2）的症状，并使用ACS评估症状群 症状检查表; 2）确定提示ACS的症状是否预测不良患者和临床结果; 3a）描述911呼叫记录上的症状报告（定性目标）;以及3b）症状模式， 集群和使用混合方法技术的结果（综合目标）。该研究将与 从北卡罗来纳州的橙子县EMS招募样本，并运送到北卡罗来纳大学 卡罗莱纳医院是一家大型学术医疗中心，在紧急心脏护理方面有着出色的项目。 研究结果将提供证据，说明症状如何与患者和临床结局相关， 可疑的进化人研究结果将促进症状科学的认识，并为未来的发展提供数据 以患者为中心的紧急心脏护理干预。从这个奖项的知识将用于R级 提案，将在第三年提交。这项以患者为导向的研究支持NINR的战略计划， 症状科学和创新的护理提供模式，以改变慢性病的轨迹。可能的长期- 这项研究的长期影响是临床实践的改变，导致生存率、功能状态和 美国和全球ACS患者的生活质量。