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Vol. 69. Issue 7.
Pages 714 (July 2016)
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Vol. 69. Issue 7.
Pages 714 (July 2016)
Letter to the Editor
DOI: 10.1016/j.rec.2016.04.012
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Health Promotion to Reduce Delays in Seeking Medical Attention in Patients With Acute Coronary Syndrome. Response
Promoción de salud para reducir el retraso en buscar atención médica de los pacientes con síndrome coronario agudo. Respuesta
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Fernando Rivero, Teresa Bastante, Javier Cuesta, Fernando Alfonso
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falf@hotmail.com

Corresponding author:
Servicio de Cardiología, Hospital Universitario de la Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
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Rev Esp Cardiol. 2016;69:71310.1016/j.rec.2016.03.016
Francisco L. Moreno-Martínez, Elibet Chávez-González, María T. Moreno-Valdés, Ricardo Oroz Moreno
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To the Editor,

We appreciate the comments of Moreno-Martínez et al concerning our article published in Revista Española de Cardiología.1 In that study, we demonstrated the importance of the delay in seeking medical attention (DSMA) as the period of time that most influences total ischemia time. Given that a decrease in time-dependent morbidity and mortality has been shown in patients with ST-segment elevation acute coronary syndrome who undergo primary percutaneous coronary interventions, the main objective of acute ischemic heart disease care networks is to reduce these times.2–4 Although published series have demonstrated that DSMA is the major determinant of total ischemia time, most of the efforts of care networks are focused on reducing the time between the call for attention and reperfusion.2–4 The general population has little knowledge of the symptoms consistent with acute coronary syndromes.5 In addition, there are discrepancies concerning the efficacy of public awareness campaigns focusing on symptom recognition and the importance of an immediate call for medical assistance.6 The results of an intervention campaign, the “Salva una vida” (Save a Life) project, which was recently conducted in Catalonia, in northeastern Spain, in conjunction with the European “Stent for Life” initiative, are pending analysis. In our study, we identified 3 major groups—older patients, women, and diabetic patients—that should be the focus of these strategies.1 Thus, we agree on the need to carry out primary prevention campaigns, with the indispensable collaboration of family medicine physicians, aiming not only toward the essential control of risk factors, but also toward making populations at high risk for DSMA aware of the need to call for assistance immediately after recognizing symptoms consistent with acute ischemic heart disease. We hope that future studies will shed light on the best way to achieve the effective implementation of these strategies in the general population.

References
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Factores asociados al retraso en la demanda de atención médica en pacientes con síndrome coronario agudo con elevación del segmento ST.
Rev Esp Cardiol., 69 (2016), pp. 279-285
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Impacto en tiempos de actuación y perfil de los pacientes tratados con angioplastia primaria en el área metropolitana sur de Barcelona al implantar el programa Código Infarto.
Rev Esp Cardiol., 65 (2012), pp. 911-918
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S.S. Rathore, J.P. Curtis, J. Chen, Y. Wang, B.K. Nallamothu, A.J. Epstein, et al.
National Cardiovascular Data Registry. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study.
BMJ., 338 (2009), pp. b1807
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C.J. Terkelsen, J.T. Sørensen, M. Maeng, L.O. Jensen, H.H. Tilsted, S. Trautner, et al.
System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention.
JAMA., 304 (2010), pp. 763-771
[5]
S. Whitaker, T. Baldwin, M. Tahir, O. Choudhry, A. Senior, S. Greenfield.
Public knowledge of the symptoms of myocardial infarction: a street survey in Birmingham.
England. Fam Pract., 29 (2012), pp. 168-173
[6]
D.B. Diercks, K.P. Owen, M.C. Kontos, A. Blomkalns, A.Y. Chen, C. Miller, et al.
Gender differences in time to presentation for myocardial infarction before and after a national women's cardiovascular awareness campaign: a temporal analysis from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation (CRUSADE) and the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (NCDR ACTION Registry-GWTG).
Am Heart J., 160 (2010),
80-7.e3
Copyright © 2016. Sociedad Española de Cardiología
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