Patients with myocardial infarction and depression are likely to be low on the priority list to the emergency, the researchers reported.
In a retrospective cohort study, heart attack patients who have traced the history of depression were more likely than other patients to score a little triage Atzema According to Chiara, MD, and colleagues at the Institute for Clinical Evaluative Sciences in Toronto.
They have also experienced considerable delays in diagnostic tests and definitive care, reported Atzema and colleagues online in CMAJ.
The researchers hypothesized that the observations could be explained by the tendency of emergency personnel to attribute symptoms of myocardial infarction in patients with depression or anxiety or somatization of depression, rather as ischemia.
In fact, most patients who come to the emergency room (ER) with heart attack symptoms such as chest pain or shortness of breath, not having a myocardial infarction, so that staff actively seeking other Possible causes of these symptoms, the researchers noted.
Atzema and colleagues noted that several studies have shown that patients with MI fare worse if they also have depression, but added that the role of emergency care of these apparently has not been tested.
To help fill the vacuum, analyzed the records of 6874 patients treated for a heart attack during a period of one year from 82 companies to hospitals in Ontario, the most populous province in Canada.
The main outcome measure, the score classification for all hospitals participating in the use of a five-point Canadian Emergency Department Triage and Acuity scale, where 1 and 2, the results are a priority, and 3, 4 and 5 are considered low.
Atzema and colleagues also examined the process of three-and-treatment: time for triage and classification of ECG at the start of fibrinolytic treatment, triage, and inflating the balloon.
For comparison, also examined the subset of patients with asthma or chronic obstructive pulmonary disease, which, like depression, are common and risk factors for myocardial infarction.
The researchers found:
MI 10% of patients - or 680 - had a history of depression.
39.1% of MI patients with depression were assigned a triage score low, compared with 32.7% of the rest of the cohort. The difference was significant at P <0.001.
A graphic record of the Depression gave an adjusted odds ratio of 1.26 meters for a low score, with 95% confidence interval 1.05 to 1.51. Betting comparable in patients with asthma and COPD were 0.88 and 1.13, respectively, but none were significant.
For patients suffering from depression, triage center at 20 minutes compared to the electrocardiogram 17 minutes for the rest of the cohort, the median time from triage to fibrinolysis was 53 minutes against 37, and the median time from triage balloon was of 251 minutes against 110.
They were much more likely than the rest of the cohort of losing the predetermined time reference for each of the measures of care processes.
The researchers cautioned that have not been confirmed by a source outside the diagnosis of depression was on the list of erectile dysfunction. He also said that it is possible that in some cases the diagnosis was lost during handling and added later by the physician.
"We suspect that these mistriage (depression) patients is not due to intentionally discriminate on the staff on duty, but rather the fact that most of the staff in the emergency room did not know the data suggest link depression and coronary artery disease," they said.
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