Israeli Survey Research Articles

Eye care professionals' patient care and personal protective equipment adapts during the second wave of SARS-CoV-2: Survey in Israel.

The coronavirus disease (COVID-19) began spreading in December 2019 and rapidly evolved to a global pandemic. Initially information was nonexistent and eye care professionals (ECPs) were anxious as the close proximity involved in patient care put them at high risk. Recognizing this stress and the probable effect on behavior initiated this survey. The survey presented here was conducted in three stages. The expectation was a change in behavior during the second wave when modes of transmission and methods of protection clarified. Yet nearly a third of ECPs still refrained from examining patients. This continuing trend can have severe health and economic ramifications.

Predicting 30-day mortality after ST elevation myocardial infarction: Machine learning- based random forest and its external validation using two independent nationwide datasets

BackgroundVarious prognostic models for mortality prediction following ST-segment elevation myocardial infarction (STEMI) have been developed over the past two decades. Our group has previously demonstrated that machine learning (ML)-based models can outperform known risk scores for 30-day mortality post-STEMI. The study aimed to redevelop an ML-based random forest prediction model for 30-day mortality post-STEMI and externally validate it on a large cohort. MethodsThis was a retrospective, supervised learning, data mining study developed on the Acute Coronary Syndrome Israeli Survey (ACSIS) registry and the Myocardial Ischemia National Audit Project (MINAP) for external validation. Patients included received reperfusion therapy for STEMI between 2006 and 2016. Discrimination and calibration performances were assessed for two developed models and compared with the Global Registry of Acute Cardiac Events (GRACE) score. ResultsThe ACSIS cohort (2,782 included /15,212 total) and MINAP cohort (22,693 included/735,000 total) were significantly different in most variables, yet similar in 30-day mortality rate (4.3–4.4%). Random forest models were developed on the ACSIS cohort with a full model including all 32 variables and a simple model including the 10 most important ones. Features’ importance was calculated using the varImp function measuring how much each feature contributes to the data's homogeneity. Applying the optimized models on the MINAP validation cohort showed high discrimination of area under the curve (AUC) = 0.804 (0.786–0.822) for the full model, and AUC = 0.787 (0.748–0.780) using the simple model, compared with the GRACE risk score discrimination of AUC = 0.764 (0.748–0.780). All models were not well calibrated for the MINAP data. Following Platt scaling on 20% of the MINAP data, the random forest models calibration improved while the GRACE calibration did not change. ConclusionsThe random forest predictive model for 30-day mortality post STEMI, developed on the ACSIS national registry, has been validated in the MINAP large external cohort and can be applied early at admission for risk stratification. The model performed better than the commonly used GRACE score. Furthermore, to the best of our knowledge, this is the first externally validated ML-based model for STEMI.

Earthquake Early Warning System in Israel—Towards an Operational Stage

The Geological Survey of Israel has upgraded and expanded the national Israeli Seismic Network (ISN), with more than 110 stations country-wide, as part of the implementation of a governmental decision to build a national Earthquake Early Warning (EEW) system named TRUAA. This upgraded seismic network exhibits a high station density and fast telemetry. The stations are distributed mainly along the main fault systems, the Dead Sea Transform, and the Carmel-Zfira Fault, which may potentially produce Mw7.5 earthquakes. The system has recently entered a limited operational phase, allowing for initial performance estimation. Real-time performance during eight months of operation (41 earthquakes) matches expectations. Alert delays (interval between origin-time and Earthquake Early Warning alert time) are reduced to as low as 3 s, and source parameter errorstatistics are within expected values found in previous works using historical data playbacks. An evolutionary alert policy is implemented based on a magnitude threshold of Mw 4.2 and peak ground accelerations exceeding 2 cm/s2. A comparison between different ground motion prediction equations (GMPE) is presented for earthquakes from Israel and California using median ground motion prediction equations values. This analysis shows that a theoretical GMPE produced the best agreement with observed ground motions, with less bias and lower uncertainties. The performance of this GMPE was found to improve when an earthquake specific stress drop is implemented.

The impact of short hospital stay on prognosis after acute myocardial infarction: An analysis from the ACSIS database.

BackgroundCurrent evidence regarding the optimal length of hospital stay (LOS) following myocardial infarction (MI) is limited. This study aimed to examine LOS policy for MI patients and to assess the safety of early discharge.MethodsA prospective observational study that included patients with STEMI and NSTEMI enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) during the years 2000–2016. Patients were divided into three subgroups according to their LOS: <3 days (short‐LOS), 3–6 days (intermediate‐LOS) and >6 days (long‐LOS). We compared baseline characteristics, management strategies and clinical outcomes at 30 days and 1 year in these groups.ResultsTen thousand four hundred and fifty eight patients were enrolled in the study. The LOS of MI patients gradually decreased over time. Short‐LOS and intermediate‐LOS patients had similar clinical characteristics while patients in the long‐LOS group were older with more co‐morbidity. There was no difference in the clinical outcomes, including re‐MI, arrhythmias, 30 days MACE, and 30 days mortality between the short‐LOS and intermediate‐LOS groups. However, the rate of re‐hospitalizations was higher in the short‐LOS group (20.9% vs. 17.8%, p = .004) without evidence of increased cardiovascular events. In multivariate analysis, the LOS did not predict either 30 days mortality (HR: 1.3; CI:0.45–5.48), nor MACE at 30 days (HR: 1.1; CI:0.79–1.56).ConclusionOur study suggests that an early discharge strategy of up to 3 days from admission is safe for low and intermediate‐risk patients after both STEMI and NSTEMI. Nevertheless, this strategy is associated with an increased risk of potential avoidable readmission and there might be psychological and social factors that may warrant a longer stay.

Pharmaceuticals in edible crops irrigated with reclaimed wastewater: Evidence from a large survey in Israel

Pharmaceuticals and other contaminants of emerging concern (CECs) are continuously introduced into the agroecosystem via reclaimed wastewater irrigation, a common agricultural practice in water-scarce regions. Although reclaimed wastewater irrigated crops are sold and consumed, only limited information is available on the occurrence of pharmaceuticals and other CECs in edible produce. Here, we report data on CECs in irrigation water, soils, and crops collected from 445 commercial fields irrigated with reclaimed wastewater in Israel. The following produce were analyzed: leafy greens, carrot, potato, tomato, orange, tangerine, avocado, and banana. Pharmaceuticals and CECs were found in quantifiable levels in all irrigation water, soils, and plants (>99.6%). Leafy greens exhibited the largest number and the highest concentration of pharmaceuticals. Within the same crop, contamination levels varied due to wastewater source and quality of treatment, and soil characteristics. Anticonvulsants (carbamazepine, lamotrigine, and gabapentin) were the most dominant therapeutic group found in the reclaimed wastewater-soil-plant continuum. Antimicrobials were detected in ~85% of the water and soil samples, however they exhibited low detection frequencies and concentrations in produce. Irrigation with reclaimed wastewater should be limited to crops where the risk for pharmaceutical transfer to the food chain is minimal.

Tsunami loss assessment based on Hazus approach – The Bat Galim, Israel, case study

The extensive loss of human lives and building damage sustained during past tsunamis drove development of the first tsunami risk assessment in Israel. Although past tsunamis have occurred along the eastern Mediterranean coasts, no data is available for empirical hazard and risk analysis. Thus, our assessment focused on a simulated tsunami generated by an Mw 8.2 earthquake along the eastern Cypriot Arc (about 200 km NW of Haifa) in Bat Galim, the most vulnerable neighborhood in the city of Haifa, situated along the Mediterranean coast in northern Israel. This tsunami event represents the worst-case scenario threatening Bat Galim. Exposure data were taken from the National Archives of the Survey of Israel and was verified with a field survey. Two approaches were taken to derive the most appropriate vulnerability models for the study: first, already published Damage Criteria (DC) were developed based on information from past tsunami events around the world; second, damage functions were applied using the Hazus Tsunami Model (HTM), a multi-parameter loss estimation tool built using detailed engineering knowledge. Risk was considered the product of hazard, exposure, and vulnerability.Following several parametric studies and sensitivity tests, we produced loss assessment results from the two most realistic model outcomes and arrived at conclusions meaningful for tsunami preparedness in northern Israel. Most importantly, we note that the loss of life far surpasses building damage. Increasing community preparedness is the simplest and most cost-effective way to significantly reduce the risk of casualties during a tsunami. We also note that upgrading the seismic design of existing structures according to required standards in Israel will decrease vulnerability to tsunamis and expand possibilities for vertical evacuation.We discuss the accuracy and reliability of our analysis and demonstrate that a simple DC approach is useful for preliminary investigation in cases of limited data. The HTM however, requires detailed preparation and data inputs but produces more realistic loss estimates. These insights may aid others during future implementation of tsunami loss modeling in threatened coastal communities.

Benefiting From Digital Use: Prospective Association of Internet Use With Knowledge and Preventive Behaviors Related to Alzheimer Disease in the Israeli Survey of Aging.

BackgroundPrevious work documented the beneficial association between internet use and improved cognition, functional capacity, and less cognitive decline among people in late adulthood. This work focused on potential mechanisms of such an association: knowledge on Alzheimer disease (AD) and preventive behaviors related to AD.ObjectiveThe aim of this study was to examine prospective associations of internet use and perceived computer skills with knowledge on AD and preventive behaviors related to AD.MethodsThe sample included 1232 older adults (mean age 71.12 [SD 9.07]) drawn from the Israeli branch of the Survey of Health, Aging, and Retirement in Europe (SHARE-Israel). The sample is representative of Israeli households of adults aged 50 or older and their spouses. Data analyzed were collected in person during 2015 (Wave 6), and in a drop-off questionnaire following the in-person 2017 data collection (Wave 7).ResultsAlthough both internet use and perceived computer skills were prospectively associated with knowledge and behaviors related to AD in bivariate analyses, after controlling for sociodemographics, only internet use was associated with more such knowledge (β=.13, P<.001) and behaviors (β=.22, P<.001).ConclusionsInternet use emerged as a prospective predictor of protective factors against AD. Policymakers should advance digital engagement so as to enhance knowledge on AD and preventive behaviors among older adults.

Do forecasters really care about consensus?

The way expectations are formed is a crucial economic issue, far from being resolved. Strategic response of forecasters to the consensus belief can explain key features of expectations formation documented in survey data. However, empirical evidence for such a response could be criticized on the basis of the underlying informational assumptions. This study exploits a special design, in an Israeli survey of firm-level inflation forecasts, which controls the information about consensus reported to the participants. We find a significant tendency of anti-herding, which is also related to the inflation level. As the inflation rate decreases, the tendency to anti-herd diminishes. This may suggest that a greater attention to inflation is associated with over-response to consensus.

Different Populations Agree on Which Moral Arguments Underlie Which Opinions.

People often justify their moral opinions by referring to larger moral concerns (e. g., “It is unfair if homosexuals are not allowed to marry!” vs. “Letting homosexuals marry is against our traditions!”). Is there a general agreement about what concerns apply to different moral opinions? We used surveys in the United States and the United Kingdom to measure the perceived applicability of eight concerns (harm, violence, fairness, liberty, authority, ingroup, purity, and governmental overreach) to a wide range of moral opinions. Within countries, argument applicability scores were largely similar whether they were calculated among women or men, among young or old, among liberals or conservatives, or among people with or without higher education. Thus, the applicability of a given moral concern to a specific opinion can be viewed as an objective quality of the opinion, largely independent of the population in which it is measured. Finally, we used similar surveys in Israel and Brazil to establish that this independence of populations also extended to populations in different countries. However, the extent to which this holds across cultures beyond those included in the current study is still an open question.

Epidural augmentation for urgent Cesarean Section : a nationwide Israeli survey

Background : Epidural augmentation to convert analgesia to emergency cesarean delivery anesthesia is a common practice. In this survey we examined the common augmentation practices in different hospitals in Israel. We investigated whether practices vary by hospital size and if written protocols for conversion correlate with intra-hospital homogeneity. Methods : A questionnaire containing 39 questions was sent to obstetric anesthesia unit heads and to four additional anesthesiologists (attending and residents) in 24 obstetric anesthesia units nationwide. Answers were received online anonymously using web-based survey site. Results : 99/120 participants responded to the survey. 80% of large hospitals have a detailed epidural augmentation protocol. The existence of a written protocol does not affect intrahospital management variability. Overall, 18 different drug mixtures for epidural augmentation were reported, and the most used drug combination is lidocaine, fentanyl and bicarbonate. In large hospitals, 72% add epinephrine and 96% initiate augmentation before operating room arrival. Most respondents reported a final administered total volume of 15-20 ml. In most hospitals there is no maternal or fetal monitoring during patient transfer from delivery room to the operating room, lasting 3.68 minutes on average, with a relative low risk of significant complication as a result of augmentation. Conclusion : We report variations in common practices, depending on hospital size. We recognized low rate of intra-hospital concordance between centers with or without a written protocol of augmentation. Regarding points for improvement, we would recommend adhering to the accepted institutional protocol.

Assessing the impacts of ALAN and noise proxies on sleep duration and quality: evidence from a nation-wide survey in Israel

ABSTRACT Sleep is a reversible state that sustains physiological and psychological processes in humans. As well established, individual-level factors, such as stress, smoking, drugs, and caffeine intake, reduce sleep duration and quality. However, studies of the effect of environmental risk factors, such as artificial light at night (ALAN) and noise, on sleep have been infrequent. Using records obtained from the 2017 Social Survey of Israel and combined with ALAN satellite data and various proxies for traffic noise, the present study aimed to determine how the combination of ALAN and traffic noise impact sleep duration and quality in urban areas. The increase of road density at the place of residence reduces average sleep duration by ~4.5% (~18 min.) and increases the frequency of reported sleep difficulties by ~3.5%, all other factors held equal. Similarly, an increase in ALAN exposure reduces average sleep duration by ~3% (~12 min) and increases the frequency of reported sleep difficulties by ~11%. The study also reveals a significant interaction between the two environmental risk factors in question, with the adverse impact of ALAN on sleep quality especially pronounced in high noise exposure areas.

Are there disparities in acute stroke treatment between the Jewish and Arab populations in Israel? Results from the National Acute Stroke Israeli registry

BackgroundAccording to the latest reported data from the National Acute Stroke Israeli Survey (NASIS), around 18,000 strokes occur annually in Israel. Data regarding disparities in stroke care between the Jewish and the Arab populations in Israel are lacking. AimsWe wished to compare demographics, comorbidities, stroke characteristics and outcomes between Jewish and Arab stroke patients in Israel that were acutely treated with intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT), in order to test if there are disparities or any ethnic-specific parameters. MethodsThe National Acute Stroke Israeli registry of patients undergoing revascularization (NASIS-REVASC) prospectively enrolled patients in six comprehensive stroke centers between 1/2014 and 3/2016. In this observational research, we compared demographics, comorbidities, time metrics, stroke characteristics and outcomes between Jewish and Arab patients enrolled. ResultsNASIS-REVASC included 1432 patients out of which 143 (10%) were of Arab ethnicity and 1289 (90%) of Jewish ethnicity. Arab patients were significantly younger (66 ± 14 vs. 73 ± 29, p = 0·004), exhibited higher rates of smoking and diabetes (31% vs. 18% and 57% vs. 34%, p < 0·001 for both), and were less often treated with systemic thrombolysis (48% vs. 59%, p = 0·012). However, the rates of any interventional treatment with either intravenous thrombolysis or endovascular thrombectomy as well as the rates of favorable outcomes and mortality were comparable between groups. ConclusionsDespite several baseline differences between Arab and Jewish Israeli stroke patients, treatment allocations, survival and functional outcomes were similar indicating lack of disparity in stroke care among patients treated acutely with IVT and/or EVT in Israel. Data access statementFull data is available following a formal request to the NASIS-REVASC registry at the Israeli Health Ministry.

Temporal Trends in Prognosis of Patients with Acute Coronary Syndrome Complicated by Ventricular Tachyarrhythmia

Objectives: To evaluate clinical characteristics and prognosis of patients presented with ventricular tachyarrhythmia (VTA) during the course of acute coronary syndrome (ACS) and to analyze it according to period of presentation. Background: VTA is an infrequent yet serious complication of ACS. There is limited data regarding the incidence and prognostic implications of VTA in the last decade as compared with the previous decade. Methods: We evaluated clinical characteristics, major adverse cardiovascular events, short and long- term mortality of patients hospitalized with ACS who were enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) during the years 2000-2016. Patients were classified into three groups: no VTA, early VTA (≤48h of onset) and late VTA (&gt;48h of onset). Data were analyzed according to decades of presentation (current decade vs. previous decade). Results: The study population comprised 15,200 patients. VTA occurred in 487 (3.2%) of patients. Early VTA presented in 373/487 (77%) patients and late VTA in 114/487 (23%) patients. VTA’s, occurring in ACS patients were associated with increased risk of in-hospital, 30-days, 1-year and 5-year mortality rates during both early and late periods in compared with no VTA. Moreover, late VTA was associated with the highest mortality rate with up to 65% in 5-year follow up (p&lt;0.001). Nevertheless, late VTA was associated with lower mortality rate in the current decade (2008-2016) compared with last decade (2000-2006). Conclusions: Any VTA following ACS was associated with high short and long-term mortality rate. Howevr, over the past decade there has been a significant improvement in survival rates, especially in patients with late VTA. This may be attributed to early and invasive reperfusion therapy, implantable cardioverter defibrillator implantation and better medical treatment.

Urban versus rural? The effects of residential status on species identification skills and connection to nature

AbstractUrbanization and urban lifestyles increasingly disconnect people from nature in a process that was termed the ‘extinction of experience’. This loss of human–nature interactions can undermine both cognitive (ecological knowledge) and affective (emotional connection to nature) relations to nature, further impacting capabilities to experience, care for, benefit from and act to protect nature. Yet, the extent to which the urban life influences both cognitive and affective relations to nature, remains poorly understood and research is confined to a few countries and cultures.We explored how cognitive and affective relations to nature can be related to people's childhood and current place of residency. We expected that urban dwellers, who have less opportunities to experience nature than their rural counterparts, will be less connected to nature and will demonstrate lower ecological knowledge than their rural counterparts.We conducted four surveys in Israel, in urban and rural settings between 2015 and 2018 (N = 1706) to measure and compare (urban vs. rural) the following variables: (a) species identification skills (correctly identified); (b) familiarity (recognized), as two measures of cognitive relation with nature and (c) nature relatedness, as a measure of emotional connection to nature.The ability to identify common plant, bird and butterfly species was poor in general (Av. = 3.83 out of 12), and lower for urban dwellers (Av. = 2.48) compared to their rural counterparts (Av. = 6.56). Differences in correct species identifications between urban and rural dwellers varied with taxa and peaked for butterflies (only 26 respondents managed to identify one species or more). We also identified an important gap between familiarity and species identification skills, especially for urban residents. Finally, people who currently live or used to live in rural areas during their childhood had higher scores of nature relatedness than their urban counterparts.Our results highlight that decreased opportunity to interact with nature reduces cognitive and affective relations to nature. Such reductions can affect the overall preferences for human–nature relationships and exacerbate a pervasive negative cycle that modifies relational values such as, care for nature, sense of belonging, place and identity that influence both humans well‐being and environmental stewardship.A freePlain Language Summarycan be found within the Supporting Information of this article.

Patients' attitudes toward conventional and herbal treatments for depression and anxiety: A cross-sectional Israeli survey.

Background:As many patients view conventional antidepressants and anxiolytics negatively, it is not surprising that the willingness to apply these treatments is far from ideal, thus posing a critical barrier in promoting an effective and durable treatment.Aim:The present study aimed to explore patients’ attitudes toward conventional and herbal treatments for depression and anxiety, while considering cultural and demographic factors, to further elucidate the antecedes that putatively determine the treatment’s outcome.Methods:During June 2017, a cross-sectional survey was conducted using stratified sampling from a large-scale Israeli volunteer online panel. The final sample included 591 Jewish Israeli adults that reported they were suffering from depression or anxiety.Results:A heterogeneous range of attitudes toward treatment was found: for example, a large group of patients did not utilize prescription medications (39%), a professional consultation (12.9%), or any form of treatment (17.4%). Interestingly, these patients were significantly more likely to support naturally-derived treatments and were less concerned with scientific proof. Further, adverse effects were demonstrated as a prominent factor in the choice of treatment. A higher incidence of adverse effects was associated with an increased willingness to consider an alternative herbal treatment. Noteworthy attitudes were found in orthodox-Jewish individuals, who showed similar consultation rates, but utilized more psychological, rather than pharmacological treatments.Conclusions:It is proposed that patients’ perspectives and cultural backgrounds are needed to be taken into consideration during the clinical assessment and choice of treatment. The findings imply that a particular emphasis should be placed on patients that discard conventional pharmacological options and on distinct cultural aspects. Several recommendations for revising the current policy are advocated to promote more culturally-informed and patient-oriented care.

Possible Indications of Variations in the Directionality of Beta-Decay Products

Some experiments seem to yield strong evidence of variability of beta-decay rates, but other experiments may show little or no such evidence. Some recent experiments help clarify the situation. In particular, a certain oscillation appears in neutrino measurements made at the Super-Kamiokande Neutrino Observatory and in radon beta-decay measurements made at the Geological Survey of Israel, with identical frequency (9.43 years−1), amplitude and phase, strengthening the case for an influence of neutrinos on beta decays. A review of current experimental information leads us to suggest that 1) beta-decay rates do not change, but 2) the angular distribution of decay products may be anisotropic, and 3) the angular distribution of decay products may be influenced by the ambient neutrino flux. It appears that experiments at standards laboratories tend to be insensitive to direction, and this may be the reason that they tend not to exhibit evidence of variability.

Outcome of patients with prior coronary bypass surgery admitted with an acute coronary syndrome

BackgroundPatients with prior coronary artery bypass graft surgery (CABG) are at increased risk for recurrent cardiovascular ischaemic events. Advances in management have improved prognosis of patients with acute coronary syndrome...

Comparison of Outcomes with or without Beta-Blocker Therapy After Acute Myocardial Infarction in Patients Without Heart Failure or Left Ventricular Systolic Dysfunction (from the Acute Coronary Syndromes Israeli Survey [ACSIS

The contemporary benefit of routine beta-blocker therapy following myocardial infraction in the absence of heart failure or left ventricular systolic dysfunction is unclear. We investigated the impact of beta-blockers on post myocardial infarction outcome in patients without heart failure or left ventricular systolic dysfunction among patients enrolled in the biennial Acute Coronary Syndrome Israeli Surveys. MACE rates at 30 days and overall mortality at one year were compared among patients discharged on beta-blockers versus not, after multivariate analysis to adjust for baseline differences. Between the years 2000 to 2016, data from 15.211consecutive ACS patients were collected. Of 7,392 patients who met the inclusion criteria, 6007 (79.9%) were discharged on beta-blocker therapy. Prescription of beta-blockers at discharge increased modestly from 32% to 38% over the 16-year period. The 30-day MACE rates were similar in patients on vs. not on beta-blockers at discharge (9.0% and 9.5%, respectively). One year survival did not differ significantly between those on vs. not on beta-blockers (HR 0.8, 95% CI 0.58 to 1.11, p = 0.18).In conclusion, beta-blocker therapy did not affect 30 days MACE or 1-year survival after myocardial infarction in patients without heart failure or reduced ejection fraction.

Female gender is associated with a worse prognosis amongst patients hospitalised for de-novo acute heart failure.

Recent evidence showed that new-onset (de-novo) acute heart failure (AHF) is a distinct type of AHF. However, the prognostic implication of gender on these patients remains unclear. We aimed to investigate the impact of gender on both short and long-term mortality outcomes after hospitalisation for de-novo AHF. We analysed the data of 721 patients with de-novo AHF, who were enrolled in the HF survey in Israel between March and April 2003 and were followed until December 2014. Fifty-four percent (N=387) of the patients were men. In comparison to women, men patients were more likely to be younger, smokers, and with ischemic HF aetiology. At 30days, mortality rates were higher in women (12% vs 7%, P=.013). Survival analysis showed that at 1 and 10years the all-cause mortality rates were significantly higher in women (28% vs 17%, and 78% vs 67%, 1 and 10years, P<.001, respectively). Consistently, multivariable analysis showed that women had an independently 82% and 24% higher mortality risk at 1 and 10years, respectively, (1-year hazard ratio=1.82; 95% confidence interval=1.07 to 3.11, P=.03; 10-year hazard ratio=1.24; 95% confidence interval=1.03 to 1.48, P=.02). Amongst patients with de-novo AHF, women had higher mortality rates compared with men. The observed gender-related differences in de-novo AHF patients highlight the need for further and deeper research in this field.

Direct Admission of Patients With ST-Segment-Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain-to-Balloon and Door-to-Balloon Time Intervals but Only the Pain-to-Balloon Interval Impacts Short- and Long-Term Mortality.

BackgroundShortening the pain‐to‐balloon (P2B) and door‐to‐balloon (D2B) intervals in patients with ST‐segment–elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) is essential in order to limit myocardial damage. We investigated whether direct admission of PPCI‐treated patients with STEMI to the catheterization laboratory, bypassing the emergency department, expedites reperfusion and improves prognosis.Methods and ResultsConsecutive PPCI‐treated patients with STEMI included in the ACSIS (Acute Coronary Syndrome in Israel Survey), a prospective nationwide multicenter registry, were divided into patients admitted directly or via the emergency department. The impact of the P2B and D2B intervals on mortality was compared between groups by logistic regression and propensity score matching. Of the 4839 PPCI‐treated patients with STEMI, 1174 were admitted directly and 3665 via the emergency department. Respective median P2B and D2B were shorter among the directly admitted patients with STEMI (160 and 35 minutes) compared with those admitted via the emergency department (210 and 75 minutes, P<0.001). Decreased mortality was observed with direct admission at 1 and 2 years and at the end of follow‐up (median 6.4 years, P<0.001). Survival advantage persisted after adjustment by logistic regression and propensity matching. P2B, but not D2B, impacted survival (P<0.001).ConclusionsDirect admission of PPCI‐treated patients with STEMI decreased mortality by shortening P2B and D2B intervals considerably. However, P2B, but not D2B, impacted mortality. It seems that the D2B interval has reached its limit of effect. Thus, all efforts should be extended to shorten P2B by educating the public to activate early the emergency medical services to bypass the emergency department and allow timely PPCI for the best outcome.