Discharge against medical advice in patients with acute coronary syndrome during the COVID-19 outbreak

Background: Patients' hesitation to seek medical care has seriously compromised the management of acute coronary syndrome during coronavirus disease 2019 (COVID-19) outbreak. In the present study, we have reported the rate of discharged against medical advice (DAMA) among patients referred to c...

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Autores principales:	Seyed Ehsan Parhizgar, Milad Vahedinezhad, Tahereh Yari, Bahareh Mohajer, Zohre Maghsoudloo, Parham Sadeghipour, Azadeh Mozayanimonfared, Zohreh Hosseini, Majid Maleki, Ata Firouzi, Mohammad Javad Alemzadeh-Ansari, Zahra Hosseini, Alireza Rashidinejad
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer Medknow Publications 2021
Materias:	acute coronary syndrome covid-19 discharged against medical advice heart pathway modified heart risk score Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/5915b86d371947a089bb73e97fa16b78
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spelling	oai:doaj.org-article:5915b86d371947a089bb73e97fa16b782021-11-12T11:12:16ZDischarge against medical advice in patients with acute coronary syndrome during the COVID-19 outbreak2251-95722251-958010.4103/rcm.rcm_23_21https://doaj.org/article/5915b86d371947a089bb73e97fa16b782021-01-01T00:00:00Zhttp://www.rcvmonline.com/article.asp?issn=2251-9572;year=2021;volume=10;issue=3;spage=79;epage=82;aulast=Parhizgarhttps://doaj.org/toc/2251-9572https://doaj.org/toc/2251-9580Background: Patients' hesitation to seek medical care has seriously compromised the management of acute coronary syndrome during coronavirus disease 2019 (COVID-19) outbreak. In the present study, we have reported the rate of discharged against medical advice (DAMA) among patients referred to chest pain unit (CPU) of a tertiary cardiovascular center and compared their clinical outcomes with whom admitted or managed conservatively. Methods: Patients with modified HEART risk score ≥4 referred to the CPU were included in the present study. Population requiring CPU admission due to positive serial troponin were divided into admitted and DAMA groups. Patients with negative serial troponin were managed as outpatient (conservative treatment group). 30-day major adverse cardiac events (MACE) and all-cause mortality were compared between the study groups. Results: A modified HEART risk score (≥4) was calculated for 440 of 5490 patients visited our CPU. One hundred and one (22.9%), 80 (18.1%), and 249 (56.5%) patients were categorized as DAMA, admitted, and conservative treatment groups, respectively. Myocardial infarction was significantly higher in the DAMA versus admitted group (2 vs. 0; P ≤ 0.001). MACE and all-cause mortality were significantly higher in the DAMA group than that in the conservative treatment group (5 vs. 2; P = 0.02 and 4 vs. 2; P = 0.055, respectively). Conclusion: In the present study, we have demonstrated a considerable rate of DAMA in patients with high modified HEART risk score referring to CPU during the COVID-19 outbreak. Importantly, the DAMA group experienced a higher incidence rate of 30-day MACE and all-cause mortality compared to patients who were admitted or managed conservatively.Seyed Ehsan ParhizgarMilad VahedinezhadTahereh YariBahareh MohajerZohre MaghsoudlooParham SadeghipourAzadeh MozayanimonfaredZohreh HosseiniMajid MalekiAta FirouziMohammad Javad Alemzadeh-AnsariZahra HosseiniAlireza RashidinejadWolters Kluwer Medknow Publicationsarticleacute coronary syndromecovid-19discharged against medical adviceheart pathwaymodified heart risk scoreDiseases of the circulatory (Cardiovascular) systemRC666-701ENResearch in Cardiovascular Medicine, Vol 10, Iss 3, Pp 79-82 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute coronary syndrome covid-19 discharged against medical advice heart pathway modified heart risk score Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	acute coronary syndrome covid-19 discharged against medical advice heart pathway modified heart risk score Diseases of the circulatory (Cardiovascular) system RC666-701 Seyed Ehsan Parhizgar Milad Vahedinezhad Tahereh Yari Bahareh Mohajer Zohre Maghsoudloo Parham Sadeghipour Azadeh Mozayanimonfared Zohreh Hosseini Majid Maleki Ata Firouzi Mohammad Javad Alemzadeh-Ansari Zahra Hosseini Alireza Rashidinejad Discharge against medical advice in patients with acute coronary syndrome during the COVID-19 outbreak
description	Background: Patients' hesitation to seek medical care has seriously compromised the management of acute coronary syndrome during coronavirus disease 2019 (COVID-19) outbreak. In the present study, we have reported the rate of discharged against medical advice (DAMA) among patients referred to chest pain unit (CPU) of a tertiary cardiovascular center and compared their clinical outcomes with whom admitted or managed conservatively. Methods: Patients with modified HEART risk score ≥4 referred to the CPU were included in the present study. Population requiring CPU admission due to positive serial troponin were divided into admitted and DAMA groups. Patients with negative serial troponin were managed as outpatient (conservative treatment group). 30-day major adverse cardiac events (MACE) and all-cause mortality were compared between the study groups. Results: A modified HEART risk score (≥4) was calculated for 440 of 5490 patients visited our CPU. One hundred and one (22.9%), 80 (18.1%), and 249 (56.5%) patients were categorized as DAMA, admitted, and conservative treatment groups, respectively. Myocardial infarction was significantly higher in the DAMA versus admitted group (2 vs. 0; P ≤ 0.001). MACE and all-cause mortality were significantly higher in the DAMA group than that in the conservative treatment group (5 vs. 2; P = 0.02 and 4 vs. 2; P = 0.055, respectively). Conclusion: In the present study, we have demonstrated a considerable rate of DAMA in patients with high modified HEART risk score referring to CPU during the COVID-19 outbreak. Importantly, the DAMA group experienced a higher incidence rate of 30-day MACE and all-cause mortality compared to patients who were admitted or managed conservatively.
format	article
author	Seyed Ehsan Parhizgar Milad Vahedinezhad Tahereh Yari Bahareh Mohajer Zohre Maghsoudloo Parham Sadeghipour Azadeh Mozayanimonfared Zohreh Hosseini Majid Maleki Ata Firouzi Mohammad Javad Alemzadeh-Ansari Zahra Hosseini Alireza Rashidinejad
author_facet	Seyed Ehsan Parhizgar Milad Vahedinezhad Tahereh Yari Bahareh Mohajer Zohre Maghsoudloo Parham Sadeghipour Azadeh Mozayanimonfared Zohreh Hosseini Majid Maleki Ata Firouzi Mohammad Javad Alemzadeh-Ansari Zahra Hosseini Alireza Rashidinejad
author_sort	Seyed Ehsan Parhizgar
title	Discharge against medical advice in patients with acute coronary syndrome during the COVID-19 outbreak
title_short	Discharge against medical advice in patients with acute coronary syndrome during the COVID-19 outbreak
title_full	Discharge against medical advice in patients with acute coronary syndrome during the COVID-19 outbreak
title_fullStr	Discharge against medical advice in patients with acute coronary syndrome during the COVID-19 outbreak
title_full_unstemmed	Discharge against medical advice in patients with acute coronary syndrome during the COVID-19 outbreak
title_sort	discharge against medical advice in patients with acute coronary syndrome during the covid-19 outbreak
publisher	Wolters Kluwer Medknow Publications
publishDate	2021
url	https://doaj.org/article/5915b86d371947a089bb73e97fa16b78
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Discharge against medical advice in patients with acute coronary syndrome during the COVID-19 outbreak

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