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

项目摘要/摘要 急性冠脉综合征(ACS)是一种潜在危及生命的急症，具有快速诊断和抢救生命的特点 再灌注治疗对于防止破坏性的患者结局是必不可少的。泽格雷-海姆西博士有广泛的 在急诊科(ED)的临床经验，在那里她致力于改善 急性冠脉综合征患者。在她的论文研究中，她研究了院前心电图学(ECG)以 提高急性冠脉综合征的早期诊断水平，为开展患者报告研究奠定了基础 她的紧急心脏护理研究的新兴项目中的症状和结果。被指导的K23 获奖是支持泽格雷-海姆西博士成为独立医生的长期目标的合乎逻辑的下一步 心血管护士科学家，以及她出色的指导团队将对她的职业发展起到关键作用。 韦恩·罗萨蒙德博士(初级)是心血管流行病学的教授和杰出的研究员， 紧急医疗服务(EMS)研究。他有着广泛的持续资助和成功的历史 指导了许多初级教员。霍利·德文博士(共同导师)是一名护理学教授和 有强烈的外部资助和成功指导的急性冠脉综合征患者的症状和性别差异 博士后和博士后研究员以及初级教员。在拟议的研究中，泽格尔-海姆西博士将获得 通过课程作业、指导和活动，掌握症状科学和混合方法研究方面的新技能 与成熟的研究团队接触。使用混合方法设计，她将研究如何 运送的成年人在院前阶段(即症状出现到急救到达)的不同症状会有不同的结果 因涉嫌急性冠脉综合征而被救护车带走。具体目标是：1)检查以下情况的发生、严重程度和变化 从院前阶段(时间1)到急诊期(时间2)的症状，并使用ACS评估症状群 症状自评量表；2)确定提示急性冠脉综合征的症状是否预示不良的患者和临床结果； 3a)描述关于911呼叫记录的症状报告(定性目标)；以及3b)症状模式， 使用混合方法技术的成果(综合目标)。这项研究将在以下方面实施 从北卡罗来纳州奥兰治县EMS招募的样本并被运送到北卡罗来纳州大学 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出色的项目。 研究结果将提供证据，证明症状与患者和临床结果之间的关系 可疑的ACS系统。研究结果将促进症状科学的知识，并为未来的发展提供数据 紧急心脏护理中以患者为中心的干预措施。从这个奖项获得的知识将用于R-Level 提案，将在第三年提交。这项以患者为中心的研究支持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，从而改善了生存、功能状态和 美国和全球急性冠脉综合征患者的生活质量。

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.