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Yang J, Zhao Y, Wang J, Ma L, Xu H, Leng W, Wang Y, Wang Y, Wang Z, Gao X, Yang Y. Current status of emergency medical service use in ST-segment elevation myocardial infarction in China: Findings from China Acute Myocardial Infarction (CAMI) Registry. Int J Cardiol 2024; 406:132040. [PMID: 38614365 DOI: 10.1016/j.ijcard.2024.132040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The mortality rate of myocardial infarction in China has increased dramatically in the past three decades. Although emergency medical service (EMS) played a pivotal role for the management of patients with ST-segment elevation myocardial infarction (STEMI), the corresponding data in China are limited. METHODS An observational analysis was performed in 26,305 STEMI patients, who were documented in China acute myocardial infarction (CAMI) Registry and treated in 162 hospitals from January 1st, 2013 to January 31th, 2016. We compared the differences such as demographic factors, social factors, medical history, risk factors, socioeconomic distribution and treatment strategies between EMS transport group and self-transport group. RESULTS Only 4336 patients (16.5%) were transported by EMS. Patients with symptom onset outside, out-of-hospital cardiac arrest and presented to province-level hospital were more likely to use EMS. Besides those factors, low systolic blood pressure, severe dyspnea or syncope, and high Killip class were also positively related to EMS activation. Notably, compared to self-transport, use of EMS was associated with a shorter prehospital delay (median, 180 vs. 245 min, P < 0.0001) but similar door-to-needle time (median, 45 min vs. 52 min, P = 0.1400) and door-to-balloon time (median, 105 min vs. 103 min, P = 0.1834). CONCLUSIONS EMS care for STEMI is greatly underused in China. EMS transport is associated with shorter onset-to-door time and higher rate of reperfusion, but not substantial reduction in treatment delays or mortality rate. Targeted efforts are needed to promote EMS use when chest pain occurs and to set up a unique regionalized STEMI network focusing on integration of prehospital care procedures in China. TRIAL REGISTRATION ClinicalTrials.gov (NCT01874691), retrospectively registered June 11, 2013.
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Affiliation(s)
- Jingang Yang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jianyi Wang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Liyuan Ma
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haiyan Xu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wenxiu Leng
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital Xiamen University, Xia Men, Fujian Province, China
| | - Zhifang Wang
- Department of Cardiology, Xinxiang Central Hospital, Xinxiang, He Nan Province, China
| | - Xiaojin Gao
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Yuejin Yang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Baradi A, Dinh DT, Brennan A, Stub D, Somaratne J, Palmer S, Nehme Z, Andrew E, Smith K, Liew D, Reid CM, Lefkovits J, Wilson A. Prevalence and Predictors of Emergency Medical Service Use in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction. Heart Lung Circ 2024; 33:990-997. [PMID: 38570261 DOI: 10.1016/j.hlc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 04/05/2024]
Abstract
AIM We aim to describe prevalence of Emergency Medical Service (EMS) use, investigate factors predictive of EMS use, and determine if EMS use predicts treatment delay and mortality in our ST-elevation myocardial infarction (STEMI) cohort. METHOD We prospectively collected data on 5,602 patients presenting with STEMI for primary percutaneous coronary intervention (PCI) transported to PCI-capable hospitals in Victoria, Australia, from 2013-2018 who were entered into the Victorian Cardiac Outcomes Registry (VCOR). We linked this dataset to the Ambulance Victoria and National Death Index (NDI) datasets. We excluded late presentation, thrombolysed, and in-hospital STEMI, as well as patients presenting with cardiogenic shock and out-of-hospital cardiac arrest. RESULTS In total, 74% of patients undergoing primary PCI for STEMI used EMS. Older age, female gender, higher socioeconomic status, and a history of prior ischaemic heart disease were independent predictors of using EMS. EMS use was associated with shorter adjusted door-to-balloon (53 vs 72 minutes, p<0.001) and symptom-to-balloon (183 vs 212 minutes, p<0.001) times. Mode of transport was not predictive of 30-day or 12-month mortality. CONCLUSIONS EMS use in Victoria is relatively high compared with internationally reported data. EMS use reduces treatment delay. Predictors of EMS use in our cohort are consistent with those prevalent in prior literature. Understanding the patients who are less likely to use EMS might inform more targeted education campaigns in the future.
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Affiliation(s)
- Arul Baradi
- Cambridge Cardiovascular Epidemiology Unit, Cambridge University, Cambridgeshire, United Kingdom; Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, Vic, Australia.
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Angela Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia
| | - Jithendra Somaratne
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand; Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Sonny Palmer
- Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, Vic, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia
| | - Emily Andrew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of General Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Andrew Wilson
- Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, Vic, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Vic, Australia
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de Diego O, Rueda F, Carrillo X, Oliveras T, Andrea R, El Ouaddi N, Serra J, Labata C, Ferrer M, Martínez-Membrive MJ, Montero S, Mauri J, García-Picart J, Rojas S, Ariza A, Tizón-Marcos H, Faiges M, Cárdenas M, Lidón RM, Muñoz-Camacho JF, Jiménez Fàbrega X, Lupón J, Bayés-Genís A, García-García C. Performance analysis of a STEMI network: prognostic impact of the type of first medical contact facility. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:708-718. [PMID: 36623690 DOI: 10.1016/j.rec.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION AND OBJECTIVES Prognosis in ST-elevation myocardial infarction (STEMI) is determined by delay in primary percutaneous coronary intervention (PPCI). The impact of first medical contact (FMC) facility type on reperfusion delays and mortality remains controversial. METHODS We performed a prospective registry of primary coronary intervention (PCI)-treated STEMI patients (2010-2020) in the Codi Infart STEMI network. We analyzed 1-year all-cause mortality depending on the FMC facility type: emergency medical service (EMS), community hospital (CH), PCI hospital (PCI-H), or primary care center (PCC). RESULTS We included 18 332 patients (EMS 34.3%; CH 33.5%; PCI-H 12.3%; PCC 20.0%). Patients with Killip-Kimball classes III-IV were: EMS 8.43%, CH 5.54%, PCI-H 7.51%, PCC 3.76% (P <.001). All comorbidities and first medical assistance complications were more frequent in the EMS and PCI-H groups (P <.05) and were less frequent in the PCC group (P <.05 for most variables). The PCI-H group had the shortest FMC-to-PCI delay (median 82 minutes); the EMS group achieved the shortest total ischemic time (median 151 minutes); CH had the longest reperfusion delays (P <.001). In an adjusted logistic regression model, the PCI-H and CH groups were associated with higher 1-year mortality, OR, 1.22 (95%CI, 1.00-1.48; P=.048), and OR, 1.17 (95%CI 1.02-1.36; P=.030), respectively, while the PCC group was associated with lower 1-year mortality than the EMS group, OR, 0.71 (95%CI 0.58-0.86; P <.001). CONCLUSIONS FMC with PCI-H and CH was associated with higher adjusted 1-year mortality than FMC with EMS. The PCC group had a much lower intrinsic risk and was associated with better outcomes despite longer revascularization delays.
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Affiliation(s)
- Oriol de Diego
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Doctorando, Programa de doctorado, Department de Medicina, Universitat Autònoma de Barcelona, Spain.
| | - Ferran Rueda
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Xavier Carrillo
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Teresa Oliveras
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Rut Andrea
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nabil El Ouaddi
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jordi Serra
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carlos Labata
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marc Ferrer
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - María J Martínez-Membrive
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Santiago Montero
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Josepa Mauri
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Servei Català de Salut, Generalitat de Catalunya, Registre del Codi Infart, Barecelona, Spain
| | - Joan García-Picart
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sergio Rojas
- Servicio de Cardiología, Hospital Joan XXIII, Tarragona, Spain
| | - Albert Ariza
- Servicio de Cardiología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group, Instituto de investigaciones Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Marta Faiges
- Servicio de Cardiología, Hospital de Tortosa Verge de la Cinta, IISPV, Tarragona, Spain
| | - Mérida Cárdenas
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, Spain
| | - Rosa María Lidón
- Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | | | - Josep Lupón
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Cosme García-García
- Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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Melgoza E, Cardenas V, Enguídanos S, Bustamante AV, Beltrán-Sánchez H. A Systematic Literature Review of Hispanic Adults' Experiences With the Emergency Medical Services System in the United States Between 2000 and 2021. Med Care 2023; 61:150-156. [PMID: 36598888 PMCID: PMC9931647 DOI: 10.1097/mlr.0000000000001817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This systematic literature review presents an overview of studies that assess the experiences of Hispanic adults with (1) activation of emergency medical services (EMS); (2) on-scene care provided by EMS personnel; (3) mode of transport (EMS vs. non-EMS) to an emergency department (ED); and (4) experiences with EMS before and during the COVID-19 pandemic. METHODS A bibliographic database search was conducted to identify relevant studies on Ovid MEDLINE (PubMed), Web of Science, EMBASE, and CINAHL. Quantitative, mixed methods, and qualitative studies published in English or Spanish were included if they discussed Hispanic adults' experiences with EMS in the US between January 1, 2000 and December 31, 2021. The Hawker and colleagues quality assessment instrument was used to evaluate the quality of studies. RESULTS Of the 43 included studies, 13 examined EMS activation, 13 assessed on-scene care, 22 discussed the mode of transport to an ED, and 4 described Hispanic adults' experiences with EMS during the COVID-19 pandemic. Hispanics were less likely to activate EMS (N=7), less likely to receive certain types of on-scene care (N=6), and less likely to use EMS as the mode of transport to an ED (N=13), compared with non-Hispanic Whites. During the early COVID-19 pandemic period (March to May 2020), EMS use decreased by 26.5% compared with the same months during the previous 4 years. CONCLUSIONS The contribution of this study is its attention to Hispanic adults' experiences with the different phases of the US EMS system.
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Affiliation(s)
- Esmeralda Melgoza
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Valeria Cardenas
- Leonard Davis School of Gerontology, University of Southern California (USC), Los Angeles, CA
| | - Susan Enguídanos
- Leonard Davis School of Gerontology, University of Southern California (USC), Los Angeles, CA
| | - Arturo Vargas Bustamante
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Hiram Beltrán-Sánchez
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
- California Center for Population Research, UCLA
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Davis LL, McCoy TP, Riegel B, McKinley S, Doering LV, Moser DK. Association of Symptoms and Mode of Transportation to Emergency Department in Patients With Acute Coronary Syndrome. Dimens Crit Care Nurs 2023; 42:95-103. [PMID: 36720034 PMCID: PMC9897491 DOI: 10.1097/dcc.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) with symptoms matching their expectations of a heart attack are more likely to use emergency medical services (EMS) than not. OBJECTIVE To determine whether presenting symptom clusters are associated with EMS use in ACS patients and if EMS use or symptom clusters are associated with prehospital delay. METHODS This secondary analysis used data from the PROMOTION trial, a randomized clinical trial that enrolled 3522 subjects with a history of or at risk for ACS from 5 sites in the United States, Australia, and New Zealand. Subjects were randomized to usual care or an educational intervention to reduce prehospital delay. During the 2-year follow-up, subjects admitted for ACS were asked about symptoms, time of symptom onset, and mode of transportation to the hospital. Symptoms were grouped into classic ACS, pain symptoms, and stress symptoms clusters. RESULTS Of 3522 subjects enrolled, 331 sought care for ACS during follow-up; 278 had transportation mode documented; 121 (44%) arrived via EMS. Classic ACS plus pain symptoms (adjusted odds ratio [AOR], 2.66; P = .011), classic ACS plus stress symptoms (AOR, 2.61; P = .007), and classic ACS plus both pain and stress symptoms (AOR, 3.90; P = .012) were associated with higher odds of EMS use versus classic ACS symptoms alone. Emergency medical services use resulted in a 68.5-minute shorter median delay (P = .002) versus non-EMS use. Symptom clusters were not predictive of delay time in the adjusted model (P = .952). DISCUSSION Although chest symptoms were the most prevalent symptoms for most (85%), the combination of classic ACS symptoms with other symptom clusters was associated with higher EMS use. Further research is needed to determine whether a combination of symptom clusters helps patients correctly interpret ACS symptoms to better understand how symptom clusters influence EMS use.
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Development of Prediction Models for Acute Myocardial Infarction at Prehospital Stage with Machine Learning Based on a Nationwide Database. J Cardiovasc Dev Dis 2022; 9:jcdd9120430. [PMID: 36547427 PMCID: PMC9784963 DOI: 10.3390/jcdd9120430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Models for predicting acute myocardial infarction (AMI) at the prehospital stage were developed and their efficacy compared, based on variables identified from a nationwide systematic emergency medical service (EMS) registry using conventional statistical methods and machine learning algorithms. Patients in the EMS cardiovascular registry aged >15 years who were transferred from the public EMS to emergency departments in Korea from January 2016 to December 2018 were enrolled. Two datasets were constructed according to the hierarchical structure of the registry. A total of 184,577 patients (Dataset 1) were included in the final analysis. Among them, 72,439 patients (Dataset 2) were suspected to have AMI at prehospital stage. Between the models derived using the conventional logistic regression method, the B-type model incorporated AMI-specific variables from the A-type model and exhibited a superior discriminative ability (p = 0.02). The models that used extreme gradient boosting and a multilayer perceptron yielded a higher predictive performance than the conventional logistic regression-based models for analyses that used both datasets. Each machine learning algorithm yielded different classification lists of the 10 most important features. Therefore, prediction models that use nationwide prehospital data and are developed with appropriate structures can improve the identification of patients who require timely AMI management.
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Farcas AM, Joiner AP, Rudman JS, Ramesh K, Torres G, Crowe RP, Curtis T, Tripp R, Bowers K, von Isenburg M, Logan R, Coaxum L, Salazar G, Lozano M, Page D, Haamid A. Disparities in Emergency Medical Services Care Delivery in the United States: A Scoping Review. PREHOSP EMERG CARE 2022; 27:1058-1071. [PMID: 36369725 DOI: 10.1080/10903127.2022.2142344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/25/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Emergency medical services (EMS) often serve as the first medical contact for ill or injured patients, representing a critical access point to the health care delivery continuum. While a growing body of literature suggests inequities in care within hospitals and emergency departments, limited research has comprehensively explored disparities related to patient demographic characteristics in prehospital care. OBJECTIVE We aimed to summarize the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group. METHODS We conducted a scoping review of peer-reviewed and non-peer-reviewed (gray) literature. We searched PubMed, CINAHL, Web of Science, Proquest Dissertations, Scopus, Google, and professional websites for studies set in the U.S. between 1960 and 2021. Each abstract and full-text article was screened by two reviewers. Studies written in English that addressed the underrepresented groups of interest and investigated EMS-related encounters were included. Studies were excluded if a disparity was noted incidentally but was not a stated objective or discussed. Data extraction was conducted using a standardized electronic form. Results were summarized qualitatively using an inductive approach. RESULTS One hundred forty-five full-text articles from the peer-reviewed literature and two articles from the gray literature met inclusion criteria: 25 studies investigated sex/gender, 61 studies investigated race/ethnicity, and 58 studies investigated both. One study investigated sexual orientation. The most common health conditions evaluated were out-of-hospital cardiac arrest (n = 50), acute coronary syndrome (n = 36), and stroke (n = 31). The phases of EMS care investigated included access (n = 55), pre-arrival care (n = 46), diagnosis/treatment (n = 42), and response/transport (n = 40), with several studies covering multiple phases. Disparities were identified related to all phases of EMS care for underrepresented groups, including symptom recognition, pain management, and stroke identification. The gray literature identified public perceptions of EMS clinicians' cultural competency and the ability to appropriately care for transgender patients in the prehospital setting. CONCLUSIONS Existing research highlights health disparities in EMS care delivery throughout multiple health outcomes and phases of EMS care. Future research is needed to identify structured mechanisms to eliminate disparities, address clinician bias, and provide high-quality equitable care for all patient populations.
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Affiliation(s)
- Andra M Farcas
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Anjni P Joiner
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jordan S Rudman
- Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Karthik Ramesh
- School of Medicine, University of California San Diego, San Diego, California
| | | | | | | | - Rickquel Tripp
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Karen Bowers
- Atlanta Fire Rescue Department; Department of Emergency Medicine, University of Tennessee-Chattanooga, Chattanooga, Tennessee
| | - Megan von Isenburg
- Duke University Medical Center Library, Duke University, Durham, North Carolina
| | - Robert Logan
- San Diego Fire - Rescue Department, San Diego, California
| | - Lauren Coaxum
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Michael Lozano
- Division of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - David Page
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ameera Haamid
- Section of Emergency Medicine, University of Chicago School of Medicine, Chicago, Illinois
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Kim DH, Moon SJ, Lee J, Cha JK, Kim MH, Park JS, Ban B, Kang J, Kim BJ, Kim WS, Yoon CH, Lee H, Kim S, Kang EK, Her AY, Yoon CW, Rha JH, Woo SI, Lee WK, Jung HY, Lee JH, Park HS, Hwang YH, Kim K, Kim RB, Choi NC, Hwang J, Park HW, Park KS, Yi S, Cho JY, Kim NH, Choi KH, Kim J, Han JY, Choi JC, Kim SY, Choi JH, Kim J, Sohn MK, Choi SW, Shin DI, Lee SY, Bae JW, Lee KS, Bae HJ. Comparison of Factors Associated With Direct Versus Transferred-in Admission to Government-Designated Regional Centers Between Acute Ischemic Stroke and Myocardial Infarction in Korea. J Korean Med Sci 2022; 37:e305. [PMID: 36325609 PMCID: PMC9623032 DOI: 10.3346/jkms.2022.37.e305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. METHODS Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. RESULTS Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI; additionally, age (65-74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. CONCLUSIONS Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.
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Affiliation(s)
- Dae-Hyun Kim
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Seok-Joo Moon
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jae-Kwan Cha
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Moo Hyun Kim
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Jong-Sung Park
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Byeolnim Ban
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihoon Kang
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won-Seok Kim
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang-Hwan Yoon
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heeyoung Lee
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seongheon Kim
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun Kyoung Kang
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ae-Young Her
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Cindy W Yoon
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Joung-Ho Rha
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Seong-Ill Woo
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Won Kyung Lee
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Han-Young Jung
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Jang Hoon Lee
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Hun Sik Park
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Yang-Ha Hwang
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Keonyeop Kim
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Rock Bum Kim
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nack-Cheon Choi
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jinyong Hwang
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyun-Woong Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki Soo Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - SangHak Yi
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Jae Young Cho
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Nam-Ho Kim
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Kang-Ho Choi
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Juhan Kim
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jae-Young Han
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jay Chol Choi
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Song-Yi Kim
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Joon-Hyouk Choi
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Jei Kim
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Min Kyun Sohn
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Si Wan Choi
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Dong-Ick Shin
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Sang Yeub Lee
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Jang-Whan Bae
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Hee-Joon Bae
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Olani A, Beza Demisse L, Alemayehu M, Sultan M. Factors Associated with Willingness to Call Emergency Medical Services for Worsening Symptoms of COVID-19 in Addis Ababa, Ethiopia. Open Access Emerg Med 2022; 14:563-572. [PMID: 36285006 PMCID: PMC9588289 DOI: 10.2147/oaem.s380566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background In response to the COVID-19 pandemic, the Ethiopian Ministry of Health has established ambulances and dispatch centers specifically designed to transport COVID-19 patients to city medical centers. Due to a lack of evidence in this area, it is critical to assess the factors that influence the willingness to call for emergency medical services. Methods A community-based cross-sectional study was conducted from June to July 2021 in Addis Ababa. The data were gathered through use of a pretested questionnaire and analyzed using SPSS 25. Logistic regression was used to calculate odds ratios with and without confounding variable controls, and significant associations were declared at (0.05). For the variables that show significant associations in bivariate and multivariate analyses, a 95% confidence interval is provided. Results Three-quarters of those surveyed said they would call ambulance if they experienced worsening COVID-19 symptoms. The individual’s language was associated with the willingness to call EMS for worsening COVID-19 symptoms [AOR 0.51(95% CI: 0.28–0.92)].; awareness of the availability of toll-free ambulance services [AOR 3.4(95% CI: 1.92–5.95)]; recalling an EMS number [AOR 4.3(95% CI: 1.71–10.67)]; ambulance crew quality of care perception [AOR 3.6(95% CI: 2.09–6.10)]; ambulance service adequacy and accessibility perception [AOR 0.25(95% CI: 0.11–0.55)]. Conclusion The study showed significant portion of the Addis Ababa community recognized the need to call EMS due to worsening COVID-19 symptoms. The individual’s language, awareness of toll-free ambulance; ability to recall an ambulance number, perception of the ambulance crew’s quality of care and adequacy and accessibility of service in the city influence the decision to call an ambulance. The finding highlights the significance of addressing problems through various media outlet, for advocacy and public awareness. More research, including qualitative studies, is needed to investigate the factors that encourage people to seek EMS.
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Affiliation(s)
- Ararso Olani
- College of Medicine and Health Science, Arba Minch University, Arbaminch, Ethiopia
| | - Lemlem Beza Demisse
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia,Correspondence: Lemlem Beza Demisse, Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Po Box 2021, Bole Road, Addis Ababa, Ethiopia, Tel +251 923-092533, Email
| | | | - Menbeu Sultan
- Department of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Song SR, Kim KH, Park JH, Song KJ, Shin SD. Association between prehospital recognition of acute myocardial infarction and length of stay in the emergency department. Clin Exp Emerg Med 2022; 9:323-332. [PMID: 36111415 PMCID: PMC9834821 DOI: 10.15441/ceem.22.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/31/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the association between prehospital recognition of acute myocardial infarction (AMI) and length of stay (LOS) in the emergency department (ED) of emergency medical service (EMS)-transported AMI patients. METHODS A multicenter retrospective observational study was conducted using prehospital and hospital data from three tertiary emergency departments. Patients diagnosed with AMI between January 2015 and December 2018 were enrolled. Study groups were categorized according to prehospital recognition and prehospital 12-lead electrocardiography (ECG) into three groups based on an EMS cardiovascular registry: group A, no prehospital recognition (reference group); group B, prehospital recognition without 12-lead ECG; and group C, prehospital recognition with 12-lead ECG. The primary outcome was an ED LOS of less than 4 hours. RESULTS Among 1,237 study participants, 722 (58.4%) were in group A, 325 (26.3%) were in group B, and 190 (15.4%) were in group C. Multivariable logistic regression showed that groups B and C had a higher likelihood of a short ED LOS (adjusted odds ratio [95% confidence interval]: group B, 1.64 [1.21-2.22] and group C, 1.88 [1.30-2.71]) than group A. There was no significant difference in ED LOS according to whether prehospital 12-lead ECG was conducted. CONCLUSION Prehospital recognition of AMI by EMS personnel, with or without 12-lead ECG, was associated with a short ED LOS.
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Affiliation(s)
- So Ra Song
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ki Hong Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea,Correspondence to: Ki Hong Kim Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea E-mail:
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
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11
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Wang X, Carcel C, Hsu B, Shajahan S, Miller M, Peters S, Randall DA, Havard A, Redfern J, Anderson CS, Jorm L, Woodward M. Differences in the pre-hospital management of women and men with stroke by emergency medical services in New South Wales. Med J Aust 2022; 217:143-148. [PMID: 35831059 PMCID: PMC9541458 DOI: 10.5694/mja2.51652] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/29/2022] [Accepted: 05/10/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To examine whether pre-hospital emergency medical service care differs for women and men subsequently admitted to hospital with stroke. DESIGN, SETTING, PARTICIPANTS Population-based cohort study; analysis of linked Admitted Patient Data Collection and NSW Ambulance data for people admitted to New South Wales hospitals with a principal diagnosis of stroke at separation, 1 July 2005 - 31 December 2018. MAIN OUTCOME MEASURES Emergency medical service assessments, protocols, and management for patients subsequently diagnosed with stroke, by sex. RESULTS Of 202 231 people hospitalised with stroke (mean age, 73 [SD, 14] years; 98 599 women [51.0%]), 101 357 were conveyed to hospital by ambulance (50.1%). A larger proportion of women than men travelled by ambulance (52.4% v 47.9%; odds ratio [OR], 1.09; 95% CI, 1.07-1.11), but time between the emergency call and emergency department admission was similar for both sexes. The likelihood of being assessed as having a stroke (adjusted OR [aOR], 0.97; 95% CI, 0.93-1.01) or subarachnoid haemorrhage (aOR, 1.22; 95% CI, 0.73-2.03) was similar for women and men, but women under 70 years of age were less likely than men to be assessed as having a stroke (aOR, 0.89; 95% CI, 0.82-0.97). Women were more likely than men to be assessed by paramedics as having migraine, other headache, anxiety, unconsciousness, hypertension, or nausea. Women were less likely than men to be managed according to the NSW Ambulance pre-hospital stroke care protocol (aOR, 0.95; 95% CI, 0.92-0.97), but the likelihood of basic pre-hospital care was similar for both sexes (aOR, 1.01; 95% CI, 0.99-1.04). CONCLUSION Our large population-based study identified sex differences in pre-hospital management by emergency medical services of women and men admitted to hospital with stroke. Paramedics should receive training that improves the recognition of stroke symptoms in women.
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Affiliation(s)
- Xia Wang
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW
| | - Cheryl Carcel
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW
| | - Benjumin Hsu
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Sultana Shajahan
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW
| | - Matthew Miller
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Sanne Peters
- The George Institute for Global HealthOxfordUnited Kingdom
| | - Deborah A Randall
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Alys Havard
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Julie Redfern
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW,School of Health Sciences, Faculty of Medicine and HealthUniversity of Sydney, NSW
| | - Craig S Anderson
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW,Royal Prince Alfred HospitalSydneyNSW
| | - Louisa Jorm
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Mark Woodward
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW
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12
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Use of emergency medical service in acute myocardial infarction in an Italian Northeastern region. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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13
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Dawson LP, Andrew E, Nehme Z, Bloom J, Biswas S, Cox S, Anderson D, Stephenson M, Lefkovits J, Taylor AJ, Kaye D, Smith K, Stub D. Association of Socioeconomic Status With Outcomes and Care Quality in Patients Presenting With Undifferentiated Chest Pain in the Setting of Universal Health Care Coverage. J Am Heart Assoc 2022; 11:e024923. [PMID: 35322681 PMCID: PMC9075482 DOI: 10.1161/jaha.121.024923] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study aimed to assess whether there are disparities in incidence rates, care, and outcomes for patients with chest pain attended by emergency medical services according to socioeconomic status (SES) in a universal health coverage setting. METHODS AND RESULTS This was a population‐based cohort study of individually linked ambulance, emergency, hospital admission, and mortality data in the state of Victoria, Australia, from January 2015 to June 2019 that included 183 232 consecutive emergency medical services attendances for adults with nontraumatic chest pain (mean age 62 [SD 18] years; 51% women) and excluded out‐of‐hospital cardiac arrest and ST‐segment–elevation myocardial infarction. Age‐standardized incidence of chest pain was higher for patients residing in lower SES areas (lowest SES quintile 1595 versus highest SES quintile 760 per 100 000 person‐years; P<0.001). Patients of lower SES were less likely to attend metropolitan, private, or revascularization‐capable hospitals and had greater comorbidities. In multivariable models adjusted for clinical characteristics and final diagnosis, lower SES quintiles were associated with increased risks of 30‐day and long‐term mortality, readmission for chest pain and acute coronary syndrome, lower acuity emergency department triage categorization, emergency department length of stay >4 hours, and emergency department or emergency medical services discharge without hospital admission and were inversely associated with use of prehospital ECGs and transfer to a revascularization‐capable hospital for patients presenting to non‐percutaneous coronary intervention centers. CONCLUSIONS In this study, lower SES was associated with a higher incidence of chest pain presentations to emergency medical services and differences in care and outcomes. These findings suggest that substantial disparities for socioeconomically disadvantaged chest pain cohorts exist, even in the setting of universal health care access.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Department of Cardiology The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Emily Andrew
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia
| | - Ziad Nehme
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia.,Department of Paramedicine Monash University Melbourne Victoria Australia
| | - Jason Bloom
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,The Baker Institute Melbourne Victoria Australia
| | - Sinjini Biswas
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Shelley Cox
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia
| | - David Anderson
- Ambulance Victoria Melbourne Victoria Australia.,Department of Intensive Care Medicine The Alfred Hospital Melbourne Victoria Australia
| | - Michael Stephenson
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia.,Department of Paramedicine Monash University Melbourne Victoria Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Department of Cardiology The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Andrew J Taylor
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Department of Medicine Monash University Melbourne Victoria Australia
| | - David Kaye
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,The Baker Institute Melbourne Victoria Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia.,Department of Paramedicine Monash University Melbourne Victoria Australia
| | - Dion Stub
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,The Baker Institute Melbourne Victoria Australia
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Kim YR, Jeong MH, An MJ, Han X, Cho KH, Sim DS, Hong YJ, Kim JH, Ahn Y. Comparison of Prognosis According to the Use of Emergency Medical Services in Patients with ST-Segment Elevation Myocardial Infarction. Yonsei Med J 2022; 63:124-132. [PMID: 35083897 PMCID: PMC8819403 DOI: 10.3349/ymj.2022.63.2.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to compare long-term clinical outcomes according to the use of emergency medical services (EMS) in patients with ST-segment elevation myocardial infarction (STEMI) who arrived at the hospital within 12 hr of symptom onset. MATERIALS AND METHODS A total of 13104 patients with acute myocardial infarction were enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health from October 2011 to December 2015. Of them, 2416 patients with STEMI who arrived at the hospital within 12 hr were divided into two groups: 987 patients in the EMS group and 1429 in the non-EMS group. Propensity score matching (PSM) was performed to reduce bias from confounding variables. After PSM, 796 patients in the EMS group and 796 patients in the non-EMS group were analyzed. The clinical outcomes during 3 years of clinical follow-up were compared between the two groups according to the use of EMS. RESULTS The symptom-to-door time was significantly shorter in the EMS group than in the non-EMS group. The EMS group had more patients with high Killip class compared to the non-EMS group. The rates of all-cause death and major adverse cardiac events (MACE) were not significantly different between the two groups. After PSM, the rate of all-cause death and MACE were still not significantly different between the EMS and non-EMS groups. The predictors of mortality were high Killip class, renal dysfunction, old age, long door-to-balloon time, long symptom-to-door time, and heart failure. CONCLUSION EMS utilization was more frequent in high-risk patients. The use of EMS shortened the symptom-to-door time, but did not improve the prognosis in this cohort.
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Affiliation(s)
- Yu Ri Kim
- Department of Cardiovacular Medicine, Chonnnam National University Hospital and Medical School, Gwangju, Korea
- College of Nursing, Chonnam National University, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovacular Medicine, Chonnnam National University Hospital and Medical School, Gwangju, Korea.
| | - Min Jeong An
- College of Nursing, Chonnam National University, Gwangju, Korea
| | - Xiongyi Han
- Department of Cardiovacular Medicine, Chonnnam National University Hospital and Medical School, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Cardiovacular Medicine, Chonnnam National University Hospital and Medical School, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiovacular Medicine, Chonnnam National University Hospital and Medical School, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovacular Medicine, Chonnnam National University Hospital and Medical School, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovacular Medicine, Chonnnam National University Hospital and Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovacular Medicine, Chonnnam National University Hospital and Medical School, Gwangju, Korea
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15
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Li N, Ma J, Zhou S, Dong X, Maimaitiming M, Jin Y, Zheng Z. Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies. Healthcare (Basel) 2021; 9:1462. [PMID: 34828508 PMCID: PMC8621169 DOI: 10.3390/healthcare9111462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/18/2022] Open
Abstract
(1) Background: Chest pain center accreditation has been associated with improved timelines of primary percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI). However, evidence from low- and middle-income regions was insufficient, and whether the sensitivity to improvements differs between walk-in and emergency medical service (EMS)-transported patients remained unclear. In this study, we aimed to examine the association of chest pain center accreditation status with door-to-balloon (D2B) time and the potential modification effect of arrival mode. (2) Methods: The associations were examined using generalized linear mixed models, and the effect modification of arrival mode was examined by incorporating an interaction term in the models. (3) Results: In 4186 STEMI patients, during and after accreditation were respectively associated with 65% (95% CI: 54%, 73%) and 71% (95% CI: 61%, 79%) reduced risk of D2B time being more than 90 min (using before accreditation as the reference). Decreases of 27.88 (95% CI: 19.57, 36.22) minutes and 26.55 (95% CI: 17.45, 35.70) minutes in D2B were also observed for the during and after accreditation groups, respectively. The impact of accreditation on timeline improvement was greater for EMS-transported patients than for walk-in patients. (4) Conclusions: EMS-transported patients were more sensitive to the shortened in-hospital delay associated with the initiative, which could exacerbate the existing disparity among patients with different arrival modes.
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Affiliation(s)
- Na Li
- Department of Global Health, School of Public Health, Peking University, Beijing 100871, China; (N.L.); (J.M.); (S.Z.); (X.D.); (Z.Z.)
- Institute for Global Health and Development, Peking University, Beijing 100871, China
| | - Junxiong Ma
- Department of Global Health, School of Public Health, Peking University, Beijing 100871, China; (N.L.); (J.M.); (S.Z.); (X.D.); (Z.Z.)
- Institute for Global Health and Development, Peking University, Beijing 100871, China
| | - Shuduo Zhou
- Department of Global Health, School of Public Health, Peking University, Beijing 100871, China; (N.L.); (J.M.); (S.Z.); (X.D.); (Z.Z.)
- Institute for Global Health and Development, Peking University, Beijing 100871, China
| | - Xuejie Dong
- Department of Global Health, School of Public Health, Peking University, Beijing 100871, China; (N.L.); (J.M.); (S.Z.); (X.D.); (Z.Z.)
- Institute for Global Health and Development, Peking University, Beijing 100871, China
| | | | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing 100871, China; (N.L.); (J.M.); (S.Z.); (X.D.); (Z.Z.)
- Institute for Global Health and Development, Peking University, Beijing 100871, China
| | - Zhijie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing 100871, China; (N.L.); (J.M.); (S.Z.); (X.D.); (Z.Z.)
- Institute for Global Health and Development, Peking University, Beijing 100871, China
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16
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Thanavaro J, Buchanan P, Stiffler M, Baum K, Bell C, Clark A, Phelan C, Russell N, Teater A, Metheny N. Factors affecting STEMI performance in six hospitals within one healthcare system. Heart Lung 2021; 50:693-699. [PMID: 34107393 DOI: 10.1016/j.hrtlng.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND How quickly percutaneous coronary intervention is performed in patients with ST-elevation myocardial infarction (STEMI) is a quality measure, reported as door-to-balloon (D2B) time. OBJECTIVES To explore factors affecting STEMI performance in six hospitals in one healthcare system. METHODS This was a retrospective chart review of clinical features and D2B times. Predictors for D2B times were identified using multivariate linear regression. RESULTS The median D2B time for all six hospitals was 63 minutes and all hospitals surpassed the minimal recommended percentage of patients achieving D2B time ≤90 minutes (87.8%vs75%,p<0.001). Patient confounders adversely affect D2B times (+21.5 minutes, p<0.001). Field ECG/activation with emergency department (ED) transport (-22.0 minutes) or direct cardiac catheterization laboratory (CCL) transport (-27.3 minutes) was superior to ED ECG/activation (p<0.001). CONCLUSION Field ECG/STEMI activation significantly shortened D2B time. To improve D2B time, hospital and Emergency Medical Service collaboration should be advocated to increase field activation and direct patient transportation to CCL.
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Affiliation(s)
- Joanne Thanavaro
- St. Louis University Trudy Busch Valentine School of Nursing, St. Louis, Missouri, USA.
| | - Paula Buchanan
- Saint Louis University's Center for Health Outcomes Research (SLUCOR), St. Louis, Missouri, USA.
| | | | | | | | | | | | | | | | - Norma Metheny
- St. Louis University Trudy Busch Valentine School of Nursing, St. Louis, Missouri, USA.
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Zhang Y, Tian Y, Dong P, Xu Y, Yu B, Li H, Li J, Ge J, Sun Y, Wang J, Wang L, Chen J, Yan H, Chen Y, Han Y, Huo Y. Treatment delay and reperfusion management of acute ST-segment elevation myocardial infarction: analysis of the China STEMI Care Project Phase 1. QJM 2021; 114:299-305. [PMID: 32569364 DOI: 10.1093/qjmed/hcaa186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/11/2020] [Accepted: 04/21/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP) was launched in 2011 to address the problems of insufficient reperfusion and long treatment delay in STEMI care in China. AIM To describe the baseline status of STEMI emergency care in Tertiary PCI Hospitals using Phase 1 (CSCAP-1) data. DESIGN CSCAP-1 is a prospective multi-center STEMI registry. METHODS AND RESULTS A total of 4191 patients with symptom onset within 12 or 12-36 h requiring primary percutaneous coronary intervention (PCI), were enrolled from 53 tertiary PCI hospitals in 14 provinces, municipalities, and autonomous regions of China in CSCAP-1. Among them, 49.0% were self-transported to the hospital, 26.5% were transferred to the hospital by calling the emergency medical services directly, and 24.5% were transferred from other hospitals. In patients with symptom onset within 12 h, 83.2% received primary PCI, 5.9% received thrombolysis and 10.9% received conservative medications. The median door-to-balloon time was 115 (85-170) min and the median door-to-needle time for in-hospital thrombolysis was 80 (50-135) min. The overall in-hospital all-cause mortality was 2.4%, while it was 5.3% in the non-reperfusion group and 2.1% in the reperfusion group (P < 0.001). CONCLUSION Although a long treatment delay and a high proportion of patients transporting themselves to the hospital were observed, trends were positive with greater adoption of primary PCI and lower in-hospital mortality in tertiary hospitals in China. Our results provided important information for further integrated STEMI network construction in China.
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Affiliation(s)
- Y Zhang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Y Tian
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 199 Dazhi Street, Nangang District, Harbin 150001, Heilongjiang Province, China
| | - P Dong
- Department of Cardiology, The First Affiliated Hospital of Henan University of Science and Technology, 24 Jinghua Road, Jianxi District, Luoyang 471003, Henan Province, China
| | - Y Xu
- Department of Cardiology, Tenth People's Hospital of Tongji University, 301 Yanchang Middle Road, Jingan District, Shanghai 200072, China
| | - B Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin 150086, Heilongjiang Province, China
| | - H Li
- Department of Cardiology, Daqing Oilfield General Hospital, 9 Zhongkang Street, Sartu District, Daqing 163001, Heilongjiang Province, China
| | - J Li
- Department of Cardiology, Qilu Hospital of Shandong University, 107 Wenhua West Road, Lixia District, Jinan 250012, Shandong Province, China
| | - J Ge
- Department of Cardiology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Y Sun
- Department of Cardiology, Shanxi Datong Coal Group General Hospital, 5999 Herui Street, Hengan New District, Datong 037003, Shanxi Province, China
| | - J Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University, 88 Jiefang Road, Shangcheng District, Hangzhou 310009, Zhejiang Province, China
| | - L Wang
- Department of Cardiology, Beijing Chao-yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing 100020, China
| | - J Chen
- Department of Cardiology, Guangdong General Hospital, 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, Guangdong Province, China
| | - H Yan
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Y Chen
- Department of Cardiology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100036, China
| | - Y Han
- Department of Cardiology, General Hospital of Northern Theater Command of People's Liberation Army, 83 Wenhua Road, Shenhe District, Shenyang 110016, Liaoning Province, China
| | - Y Huo
- Department of Cardiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
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18
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Erol MK, Kayıkçıoğlu M, Kılıçkap M, Güler A, Öztürk Ö, Tuncay B, İnci S, Balaban İ, Tatar F, Çırakoğlu ÖF, Gazi E, Bakırcı EM, Yayla Ç, Astarcıoğlu MA, Duran Karaduman B, Aksu E, Alsancak Y, Emlek N, Tigen MK, Turhan Cağlar N, Düz R, Inanir M, Özdoğan Ö, Yavuzgil O. Time delays in each step from symptom onset to treatment in acute myocardial infarction: Results from a nation-wide TURKMI registry. Anatol J Cardiol 2021; 25:294-303. [PMID: 33960304 DOI: 10.5152/anatoljcardiol.2021.39797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. METHODS The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). RESULTS After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. CONCLUSION The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.
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Affiliation(s)
- Mustafa Kemal Erol
- Department Of Cardiology, Şişli International Kolan Hospital; Istanbul-Turkey
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Faculty of Medicine, Ege University; İzmir-Turkey
| | - Mustafa Kılıçkap
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
| | - Arda Güler
- Department of Cardiology, Health Science University, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey
| | - Önder Öztürk
- Department of Cardiology, Health Science University, Gazi Yaşargil Training and Research Hospital; Diyarbakır-Turkey
| | - Burcu Tuncay
- Department of Cardiology, Health Science University, Bursa Yüksek İhtisas Training and Research Hospital; Bursa-Turkey
| | - Sinan İnci
- Department of Cardiology, Faculty of Medicine, Aksaray University; Aksaray-Turkey
| | - İsmail Balaban
- Department of Cardiology, Health Science University, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Fatih Tatar
- Department of Cardiology, Faculty of Medicine, Bülent Ecevit University; Zonguldak-Turkey
| | - Ömer Faruk Çırakoğlu
- Department of Cardiology, Health Science University, Ahi Evran Thoracic and Cardiovascular Surgery Training and Research Hospital; Trabzon-Turkey
| | - Emine Gazi
- Department of Cardiology, Faculty of Medicine, Onsekiz Mart University; Çanakkale-Turkey
| | - Eftal Murat Bakırcı
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yıldırım University; Erzincan-Turkey
| | - Çağrı Yayla
- Department of Cardiology, Health Science University, Türkiye Yüksek İhtisas Training and Research Hospital; Ankara-Turkey
| | - Mehmet Ali Astarcıoğlu
- Department of Cardiology, Yıldırım Beyazıt University, Atatürk Training and Research Hospital; Ankara-Turkey
| | - Bilge Duran Karaduman
- Department of Cardiology, Dumlupınar University, Evliya Çelebi Training and Research Hospital; Kütahya-Turkey
| | - Ekrem Aksu
- Department of Cardiology, Faculty of Medicine, Sütçü İmam University; Kahramanmaras-Turkey
| | - Yakup Alsancak
- Department of Cardiology, Faculty of Medicine, Necmettin Erbakan University; Konya-Turkey
| | - Nadir Emlek
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University; Rize-Turkey
| | - Mustafa Kürşat Tigen
- Department of Cardiology, Faculty of Medicine, Marmara University; İstanbul-Turke
| | - Nihan Turhan Cağlar
- Department of Cardiology, Health Science University, Bakırköy Dr. Sadi Konuk Training and Research Hospital; İstanbul-Turkey
| | - Ramazan Düz
- Department of Cardiology, Health Science University, Van Training and Research Hospital; Van-Turkey
| | - Mehmet Inanir
- Department of Cardiology, Faculty of Medicine, Abant İzzet Baysal University; Bolu-Turkey
| | - Öner Özdoğan
- Department of Cardiology, Health Science University, Tepecik Training and Research Hospital; İzmir-Turkey
| | - Oğuz Yavuzgil
- Department of Cardiology, Faculty of Medicine, Ege University; İzmir-Turkey
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19
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A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction. Sci Rep 2021; 11:6358. [PMID: 33737723 PMCID: PMC7973784 DOI: 10.1038/s41598-021-86013-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022] Open
Abstract
Timely performing electrocardiography (ECG) is crucial for early detection of ST-elevation myocardial infarction (STEMI). For shortening door-to-ECG time, a chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside ECG after focused history-taking was implemented at the emergency department (ED) in a single tertiary referral center. All patients diagnosed with STEMI visiting the ED between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of strategy before and after implantation. Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n = 57; post-intervention group, n = 60) showed significant overall improvements in median door-to-ECG time from 5 to 4 min (p = 0.02), achievement rate of door-to-ECG time < 10 min from 45 to 57% (p = 0.01), median door-to-balloon time from 81 to 70 min (p < 0.01). Significant trends of increase in achievement rates for door-to-ECG and door-to-balloon times (p = 0.032 and p = 0.002, respectively) was noted after strategy implementation. The incidences of door-to-ECG time > 10 min for those with initially underestimated disease severity (from 90 to 10%, p < 0.01) and walk-in (from 29.2 to 8.8%, p = 0.04) were both reduced. In conclusion, a chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.
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20
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Choi A, Kim MJ, Sung JM, Kim S, Lee J, Hyun H, Kim JH, Chang HJ. Development of Prediction Models for Acute Myocardial Infarction at Prehospital Stage with Machine Learning Based on a Nationwide Database (Preprint). JMIR Med Inform 2021. [DOI: 10.2196/27405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Sun P, Li J, Fang W, Su X, Yu B, Wang Y, Li C, Chen H, Wang X, Zhang B, Li Y, Momin M, Shi Y, Wang H, Zhang Y, Xiang D, Huo Y. Effectiveness of chest pain centre accreditation on the management of acute coronary syndrome: a retrospective study using a national database. BMJ Qual Saf 2020; 30:867-875. [PMID: 33443197 DOI: 10.1136/bmjqs-2020-011491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Large-scale real-world data to evaluate the impact of chest pain centre (CPC) accreditation on acute coronary syndrome (ACS) emergency care in heavy-burden developing countries like China are rare. METHODS This study is a retrospective study based on data from the Hospital Quality Monitoring System (HQMS) database. This study included emergency patients admitted with ACS to hospitals that uploaded clinical data continuously to the database from 2013 to 2016. Propensity score matching was used to compare hospitals with and without CPC accreditation during this period. A longitudinal self-contrast comparison design with mixed-effects models was used to compare management of ACS before and after accreditation. RESULTS A total of 798 008 patients with ACS from 746 hospitals were included in the analysis. After matching admission date, hospital levels and types and adjusting for possible covariates, patients with ACS admitted to accredited CPCs had lower in-hospital mortality (OR=0.70, 95% CI 0.53 to 0.93), shorter length of stay (LOS; adjusted multiplicative effect=0.89, 95% CI 0.84 to 0.94) and more percutaneous coronary intervention (PCI) procedures (OR=3.53, 95% CI 2.20 to 5.66) than patients admitted in hospitals without applying for CPC accreditation. Furthermore, when compared with the 'before accreditation' group only in accredited CPCs, the in-hospital mortality and LOS decreased and the usage of PCI were increased in both 'accreditation' (for in-hospital mortality: OR=0.86, 95% CI 0.79 to 0.93; for LOS: 0.94, 95% CI 0.93 to 0.95; for PCI: OR=1.22, 95% CI 1.18 to 1.26) and 'after accreditation' groups (for in-hospital mortality: OR=0.90, 95% CI 0.84 to 0.97; for LOS: 0.89, 95% CI 0.89 to 0.90; for PCI: OR=1.36, 95% CI 1.33 to 1.39). The significant benefits of decreased in-hospital mortality, reduced LOS and increased PCI usage were also observed for patients with acute myocardial infarction. CONCLUSIONS CPC accreditation is associated with better management and in-hospital clinical outcomes of patients with ACS. CPC establishment and accreditation should be promoted and implemented in countries with high levels of ACS.
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Affiliation(s)
- Pengfei Sun
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Weiyi Fang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital Xiamen university, Xiamen, Fujian, China
| | - Chunjie Li
- Emergency Department, Tianjin Chest Hospital, Tianjin, China
| | - Hu Chen
- Corporate Ethics Department, Bureau of Medical Administration National Health Commission of the People's Republic of China, Beijing, China
| | - Xingang Wang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yuxi Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Mohetaboer Momin
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen, Guangdong, China
| | - Haibo Wang
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Dingcheng Xiang
- Department of Cardiology, General Hospital of Southern Theatre Command of PLA, Guangzhou, Guangdong, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
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22
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Samsky MD, Krucoff MW, Morrow DA, Abraham WT, Aguel F, Althouse AD, Chen E, Cigarroa JE, DeVore AD, Farb A, Gilchrist IC, Henry TD, Hochman JS, Kapur NK, Morrow V, Ohman EM, O'Neill WW, Piña IL, Proudfoot AG, Sapirstein JS, Seltzer JH, Senatore F, Shinnar M, Simonton CA, Tehrani BN, Thiele H, Truesdell AG, Waksman R, Rao SV. Cardiac safety research consortium "shock II" think tank report: Advancing practical approaches to generating evidence for the treatment of cardiogenic shock. Am Heart J 2020; 230:93-97. [PMID: 33011148 DOI: 10.1016/j.ahj.2020.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
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23
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Ballarino P, Cervellin G, Trucchi C, Altomonte F, Bertini A, Bonfanti L, Bressan MA, Carpinteri G, Noto P, Gavelli F, Molinari L, Patrucco F, Sainaghi PP, Caristia S, Cavazza M, Gallitelli M, Longo S, Cremonesi P, Orsi A, Ansaldi F, Marino R, Di Somma S, Castello LM, Moscatelli P, Avanzi GC. An Italian registry of chest pain patients in the emergency department: clinical predictors of acute coronary syndrome. Minerva Med 2020; 111:120-132. [PMID: 32338841 DOI: 10.23736/s0026-4806.20.06472-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aim of this study was to describe the population of patients arriving in several Italian Emergency Departments (EDs) complaining of chest pain suggestive of acute coronary syndrome (ACS) in order to evaluate the incidence of ACS in this cohort and the association between ACS and different clinical parameters and risk factors. METHODS This is an observational prospective study, conducted from the 1st January to the 31st December 2014 in 11 EDs in Italy. Patients presenting to ED with chest pain, suggestive of ACS, were consecutively enrolled. RESULTS Patients with a diagnosis of ACS (N.=1800) resulted to be statistically significant older than those without ACS (NO ACS; N.=4630) (median age: 70 vs. 59, P<0.001), and with a higher prevalence of males (66.1% in ACS vs. 57.5% in NO ACS, P<0.001). ECG evaluation, obtained at ED admission, showed new onset alterations in 6.2% of NO ACS and 67.4% of ACS patients. Multiple logistic regression analysis showed that the following parameters were predictive for ACS: age, gender, to be on therapy for cardio-vascular disease (CVD), current smoke, hypertension, hypercholesterolemia, heart rate, ECG alterations, increased BMI, reduced SaO2. CONCLUSIONS Results from this observational study strengthen the importance of the role of the EDs in ruling in and out chest pain patients for the diagnosis of ACS. The analysis put in light important clinical and risk factors that, if promptly recognized, can help Emergency Physicians to identify patients who are more likely to be suffering from ACS.
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Affiliation(s)
- Paola Ballarino
- Emergency Department, San Martino University Hospital, Genoa, Italy
| | | | - Cecilia Trucchi
- Department of Health Science, University of Genoa, Genoa, Italy
| | | | | | - Laura Bonfanti
- Emergency Department, Parma University Hospital, Parma, Italy
| | - Maria A Bressan
- Emergency Department, San Matteo University Hospital, Pavia, Italy
| | | | - Paola Noto
- Emergency Department, Vittorio Emanuele University Hospital, Catania, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Luca Molinari
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Filippo Patrucco
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Silvia Caristia
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Mario Cavazza
- Emergency Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mauro Gallitelli
- Emergency Department, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Stefania Longo
- Internal Medicine and Emergency Department, Bari University Hospital, Bari, Italy
| | | | - Andrea Orsi
- Department of Health Science, University of Genoa, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Science, University of Genoa, Genoa, Italy
| | - Rossella Marino
- Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Luigi M Castello
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy - .,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Paolo Moscatelli
- Emergency Department, San Martino University Hospital, Genoa, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
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24
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Harrington RA, Califf RM, Balamurugan A, Brown N, Benjamin RM, Braund WE, Hipp J, Konig M, Sanchez E, Joynt Maddox KE. Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association. Circulation 2020; 141:e615-e644. [PMID: 32078375 DOI: 10.1161/cir.0000000000000753] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Understanding and addressing the unique health needs of people residing in rural America is critical to the American Heart Association's pursuit of a world with longer, healthier lives. Improving the health of rural populations is consistent with the American Heart Association's commitment to health equity and its focus on social determinants of health to reduce and ideally to eliminate health disparities. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders to make rural populations a priority in programming, research, and policy. This advisory first summarizes existing data on rural populations, communities, and health outcomes; explores 3 major groups of factors underlying urban-rural disparities in health outcomes, including individual factors, social determinants of health, and health delivery system factors; and then proposes a set of solutions spanning health system innovation, policy, and research aimed at improving rural health.
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25
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Lee SH, Kim HK, Jeong MH, Lee JM, Gwon HC, Chae SC, Seong IW, Park JS, Chae JK, Hur SH, Cha KS, Kim HS, Seung KB, Rha SW, Ahn TH, Kim CJ, Hwang JY, Choi DJ, Yoon J, Joo SJ, Hwang KK, Kim DI, Oh SK. Pre-hospital delay and emergency medical services in acute myocardial infarction. Korean J Intern Med 2020; 35:119-132. [PMID: 31766823 PMCID: PMC6960059 DOI: 10.3904/kjim.2019.123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/19/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Minimising total ischemic time (TIT) is important for improving clinical outcomes in patients with ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention (PCI). TIT has not shown a significant improvement due to persistent pre-hospital delay. This study aimed to investigate the risk factors associated with pre-hospital delay. METHODS Individuals enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health between 2011 and 2015 were included in this study. The study population was analyzed according to the symptom-to-door time (STDT; within 60 or > 60 minutes), and according to the type of hospital visit (emergency medical services [EMS], non-PCI center, or PCI center). RESULTS A total of 4,874 patients were included in the analysis, of whom 28.4% arrived at the hospital within 60 minutes of symptom-onset. Old age (> 65 years), female gender, and renewed ischemia were independent predictors of delayed STDT. Utilising EMS was the only factor shown to reduce STDT within 60 minutes, even when cardiogenic shock was evident. The overall frequency of EMS utilisation was low (21.7%). Female gender was associated with not utilising EMS, whereas cardiogenic shock, previous myocardial infarction, familial history of ischemic heart disease, and off-hour visits were associated with utilising EMS. CONCLUSION Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.
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Affiliation(s)
- Seung Hun Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Kuk Kim
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Correspondence to Myung Ho Jeong, M.D. Department of Cardiology, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju 61469, Korea Tel: +82-62-220-6243, Fax: +82-62-228-7174, E-mail:
| | - Joo Myung Lee
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - In-Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jong-Seon Park
- Division of Cardiology, Yeungnam University Medical Centre, Daegu, Korea
| | - Jei Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Seung-Ho Hur
- Department of Cardiovascular Medicine, Keimyung University Dongsan Medical Centre, Daegu, Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Hyo-Soo Kim
- Cardiovascular Centre, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Centre, Korea University Guro Hospital, Seoul, Korea
| | - Tae Hoon Ahn
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Chong-Jin Kim
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong-Ju Choi
- Cardiovascular Centre, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Doo-Il Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Seok Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
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Comparison of effects of thrombolytic therapy and primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction on in-hospital, six-month, and one-year mortality. ACTA ACUST UNITED AC 2019; 4:e82-e88. [PMID: 31211274 PMCID: PMC6554752 DOI: 10.5114/amsad.2019.85378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/18/2019] [Indexed: 01/29/2023]
Abstract
Introduction This study aims to evaluate the effect of primary percutaneous coronary intervention (PCI) and thrombolytic therapy (TT) on the in-hospital adverse events, in-hospital and long-term mortality in patients over 65 years of age with acute ST-segment elevation myocardial infarction (STEMI). Material and methods A total of 111 retrospectively screened patients (73 males, mean age: 73.4 ±5.9 years) over 65 years of age with STEMI, who underwent TT or primary PCI, were included in the study. Patients' characteristics, in-hospital outcomes, and 6-month and 1-year mortalities were recorded. Results Our study was conducted with 111 patients over 65 years of age with STEMI (73 males, 38 females). Of the patients, 66 (59.5%) were treated with thrombolytics, and 45 (40.5%) patients underwent primary PCI. Door-to-needle time was 25.9 ±7.8 min in the TT group, whereas door-to-balloon time was 84.4 ±20.0 min in the PCI group. Time from symptom onset to hospital admission was 213.6 ±158.4 min in the thrombolytic group, and 166.8 ±112.8 min in the PCI group. Rescue PCI was performed in 7 (10.6%) patients in the TT group due to lack of reperfusion. Recurrent infarction was observed in 5 (7.6%) patients in the TT group and in 2 (4.4%) patients in the PCI group. Non-haemorrhagic stroke was observed in 1 (1.5%) patient in the thrombolytic-administered group and in 4 (8.9%) patients in the PCI group. No intracranial haemorrhage was observed in any patient. Major haemorrhage was observed in 4 (6.1%) patients in the TT group and in 4 (8.9%) patients in the PCI group. Six-month and 1-year mortalities were present in 15 (22.7%) patients and 19 patients in thrombolytic group, and 8 (17.8%) and 8 (17.8%) patients in the PCI group, respectively. Binary logistic regression analysis indicated that the patient's age was the only predictor for 1-year mortality (odds ratio (OR) = 1.1, 95% confidence interval (CI): 1.019-1.188, p = 0.015). Conclusions Considering the in-hospital adverse outcomes, in-hospital mortality, and 6-month mortality rates, TT and primary PCI have similar effects in STEMI patients aged 65 years and over according to the results of our study. Although 1-year mortality was higher in the TT group, it was not statistically significant.
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Kim DY, Wala Z, Islam S, Islam R, Ahn M. Clinical characteristics and outcomes of ST-segment elevation myocardial infarction in a low income setting in rural Bangladesh. IJC HEART & VASCULATURE 2019; 23:100376. [PMID: 31193421 PMCID: PMC6527896 DOI: 10.1016/j.ijcha.2019.100376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In rural areas of Bangladesh, the majority of patients with ST segment elevation myocardial infarction (STEMI) have little access to reperfusion therapy. Even though thrombolysis can be an affordable life-saving treatment in a low income setting, there are few publications in regards to the clinical and socioeconomic features of STEMI with thrombolytic therapy in rural Bangladesh. METHOD The information of the patients who were admitted for STEMI between 2010 and 2016 from one rural hospital were collected and reviewed. This audit evaluated clinical outcomes and socioeconomic characteristics of the patients. RESULT 164 patients with STEMI were identified in the period and 136 patients (82.93%) underwent thrombolysis. The mean pain-to-door time was 472 min (7.87 h ± 12.40). Only 5.49% of the patients traveled to hospital by ambulances. Overall in-hospital mortality rate and major adverse cardiovascular event (MACE) after STEMI were 19.51% (32/164), 23.17% (38/164), respectively. The need of inotropics (Odds ratio [OR] 16.43, 95% confidence interval [CI] 1.99-135.75, P < 0.01), the use of defibrillation due to ventricular arrhythmias (OR 33.58, 95% CI 2.96-380.49, P < 0.01) were independent predictors of increased in-hospital mortality. CONCLUSION In a rural hospital of Bangladesh, in-hospital mortality rate after STEMI is high in spite of thrombolysis and adherence to published guidelines. The prolonged pain-to-door time and the poor coverage of ambulance services in our study highlight the need of community awareness of acute coronary syndrome and comprehensive emergency medical services in rural Bangladesh.
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Affiliation(s)
- Dong-Yeon Kim
- Corresponding author at: Department of Internal Medicine, LAMB Hospital, Rajabashor, Parbatipur, Dinajpur 5250, Bangladesh.
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Kimura K, Kimura T, Ishihara M, Nakagawa Y, Nakao K, Miyauchi K, Sakamoto T, Tsujita K, Hagiwara N, Miyazaki S, Ako J, Arai H, Ishii H, Origuchi H, Shimizu W, Takemura H, Tahara Y, Morino Y, Iino K, Itoh T, Iwanaga Y, Uchida K, Endo H, Kongoji K, Sakamoto K, Shiomi H, Shimohama T, Suzuki A, Takahashi J, Takeuchi I, Tanaka A, Tamura T, Nakashima T, Noguchi T, Fukamachi D, Mizuno T, Yamaguchi J, Yodogawa K, Kosuge M, Kohsaka S, Yoshino H, Yasuda S, Shimokawa H, Hirayama A, Akasaka T, Haze K, Ogawa H, Tsutsui H, Yamazaki T. JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome. Circ J 2019; 83:1085-1196. [DOI: 10.1253/circj.cj-19-0133] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Masaharu Ishihara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital
| | - Katsumi Miyauchi
- Cardiovascular Medicine, Juntendo Tokyo Koto Geriatric Medical Center
| | - Tomohiro Sakamoto
- Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science
| | | | - Shunichi Miyazaki
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hideki Origuchi
- Department of Internal Medicine, Japan Community Health Care Organization Kyushu Hospital
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Kenji Iino
- Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University
| | - Tomonori Itoh
- Department of Medical Education, Iwate Medical University
| | - Yoshitaka Iwanaga
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine
| | - Keiji Uchida
- Division of Cardiovascular Surgery, Yokohama City University Medical Center
| | - Hirohisa Endo
- Department of Cardiovascular Medicine, Juntendo University Hospital
| | - Ken Kongoji
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Hospital
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women’s Medical University
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Hospital
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University Medical Center
| | | | | | - Takahiro Nakashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Gradiate School of Medical and Dental Science
| | | | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Hideaki Yoshino
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Kazuo Haze
- Department of Cardiology, Kashiwara Municipal Hospital
| | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Science, Kyushu University Graduate School of Medical Science
| | - Tsutomu Yamazaki
- Innovation & Research Center, International University of Health and Welfare
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Gibson CM, Holmes D, Mikdadi G, Presser D, Wohns D, Yee MK, Kaplan A, Ciuffo A, Eberly AL, Iteld B, Krucoff MW. Implantable Cardiac Alert System for Early Recognition of ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2019; 73:1919-1927. [DOI: 10.1016/j.jacc.2019.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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Park JH, Moon SW, Kim TY, Ro YS, Cha WC, Kim YJ, Shin SD. Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study. Clin Exp Emerg Med 2018; 5:264-271. [PMID: 30571905 PMCID: PMC6301859 DOI: 10.15441/ceem.17.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/26/2017] [Indexed: 12/13/2022] Open
Abstract
Objective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI. Methods Patients transported by EMS to 4 study hospitals from 2008 to 2012 were included. Using EMS and administrative emergency department databases, patients were stratified according to the presence of EMS-assessed cardiac symptoms and emergency department diagnosis of AMI. Cardiac symptoms were defined as chest pain, dyspnea, palpitations, and syncope. Disproportionate stratified sampling was used, and medical records of sampled patients were reviewed to identify an actual diagnosis of AMI. Using inverse probability weighting, verification bias-corrected diagnostic performance was estimated. Results Overall, 92,353 patients were enrolled in the study. Of these, 13,971 (15.1%) complained of cardiac symptoms to EMS providers. A total of 775 patients were sampled for hospital record review. The sensitivity, specificity, positive predictive value, and negative predictive value of EMS provider-assessed cardiac symptoms for the final diagnosis of AMI was 73.3% (95% confidence interval [CI], 70.8 to 75.7), 85.3% (95% CI, 85.3 to 85.4), 3.9% (95% CI, 3.6 to 4.2), and 99.7% (95% CI, 99.7 to 99.8), respectively. Conclusion We found that EMS provider-assessed cardiac symptoms had moderate sensitivity and high specificity for diagnosis of AMI. EMS policymakers can use these data to evaluate the pertinence of specific prehospital treatment of AMI.
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Affiliation(s)
- Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Woo Moon
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Tae Yun Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Won Chul Cha
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu Jin Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Bainey KR, Alemayehu W, Gupta AK, Bowker SL, Welsh RC, Kaul P. Ethnic and sex differences in ambulance activation among hospitalized patients with acute coronary syndromes: Insights from the Alberta contemporary acute coronary syndrome patients invasive treatment strategies (COAPT) study. Int J Cardiol 2018; 272:33-39. [DOI: 10.1016/j.ijcard.2018.08.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/19/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
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Mehmood A, Rowther AA, Kobusingye O, Hyder AA. Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach. Int J Emerg Med 2018; 11:53. [PMID: 31179939 PMCID: PMC6326122 DOI: 10.1186/s12245-018-0207-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/26/2018] [Indexed: 11/10/2022] Open
Abstract
Emergency medical services (EMS) is defined as the system that organizes all aspects of care provided to patients in the pre-hospital or out-of-hospital environment. Hence, EMS is a critical component of the health systems and is necessary to improve outcomes of injuries and other time-sensitive illnesses. Still there exists a substantial need for evidence to improve our understanding of the capacity of such systems as well as their strengths, weaknesses, and priority areas for improvement in low-resource environments. The aim was to develop a tool for assessment of the pre-hospital EMS system using the World Health Organization (WHO) health system framework. Relevant literature search and expert consultation helped identify variables describing system capacity, outputs, and goals of pre-hospital EMS. Those were organized according to the health systems framework, and a multipronged approach is proposed for data collection including use of qualitative and quantitative methods with triangulation of information from important stakeholders, direct observation, and policy document review. The resultant information is expected to provide a holistic picture of the pre-hospital emergency medical services and develop key recommendations for PEMS systems strengthening.
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Affiliation(s)
- Amber Mehmood
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Armaan Ahmed Rowther
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | | | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Eindhoven DC, Wu HW, Kremer SWF, van Erkelens JA, Cannegieter SC, Schalij MJ, Borleffs CJW. Mortality differences in acute myocardial infarction patients in the Netherlands: The weekend-effect. Am Heart J 2018; 205:70-76. [PMID: 30176441 DOI: 10.1016/j.ahj.2018.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 07/24/2018] [Indexed: 11/18/2022]
Abstract
Objective Several studies have shown that patients admitted with an acute myocardial infarction during the weekends have a higher mortality rate than those admitted during weekdays, possibly attributable to less trained personnel available and a lower use of medical procedures. The current study aimed to assess this ‘weekend-effect’ in a nationwide registry. Methods In the Netherlands, all inhabitants are, by law, obliged to have health insurance and all claim data are centrally registered. In 2012 and 2013, all national diagnose-codings of STEMI and NSTEMI patients were acquired. One-year mortality rates and treatment with percutaneous coronary intervention (PCI) were compared between weekdays and weekends (holidays included). Results In total, 59,534 patients (67 ± 13 years, 39,545(66%) male) were included of whom 33,904(57%) had a NSTEMI. Overall 6857(12%) patients died in the year following the acute myocardial infarction registration. In STEMI patients, no differences in one-year mortality rates were observed between admission on weekdays or weekends. In NSTEMI patients, one-year mortality was higher in those admitted during weekends (weekdays 11% versus weekends 13%, P < .001). Furthermore, STEMI patients admitted during weekends were more often treated with PCI (weekdays 77% versus weekends 81%, P < .001). Conversely, NSTEMI patients admitted during weekends were less often treated with PCI (weekdays 35% versus weekends 32%, P < .001). Conclusion Differences in treatment and mortality rates exist between acute myocardial infarction patients admitted during weekdays and weekends. NSTEMI patients admitted during weekends are less often treated with PCI and have a higher mortality rate than patients admitted during weekdays.
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Affiliation(s)
- Daniëlle C Eindhoven
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hoi W Wu
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stijn W F Kremer
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Suzanne C Cannegieter
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Balamurugan A, Phillips M, Selig JP, Felix H, Ryan K. Association Between System Factors and Acute Myocardial Infarction Mortality. South Med J 2018; 111:556-564. [PMID: 30180254 DOI: 10.14423/smj.0000000000000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We conducted a cross-sectional study to assess the association between healthcare system factors and death from acute myocardial infarction (AMI), in terms of access (distance to the hospital, mode of transportation), availability (emergency medical services, hospitals), and capability (emergency medical services' 12-lead electrocardiogram capability, continuous percutaneous coronary intervention [PCI] and cardiothoracic surgical services), after accounting for individual and environmental factors. METHODS Data on 14,663 deaths (in-hospital and out of hospital) and live hospital discharges as a result of AMI for 2012 and 2013 among Arkansas residents were obtained from the Arkansas Department of Health. A mixed-effects logistic regression model was used to account for nesting, in which an individual was nested within either a county or a hospital to evaluate the association of system factors with death from AMI. RESULTS Deaths from AMI were significantly associated with two system factors: a 9.2% increase in the odds of deaths from AMI for every 10-mi increase in distance to the nearest hospital (odds ratio 1.092, 95% confidence interval 1.009-1.181) and a 64% increase in the odds of death from AMI among hospitals without continuous PCI capability (odds ratio 1.64, 95% confidence interval 1.15-2.34), after adjusting for individual and environmental factors. CONCLUSIONS A higher risk of AMI deaths was associated with healthcare system factors, especially distance to nearest hospital, and hospitals' continuous PCI capability, even after adjusting for individual and environmental factors. A coordinated system of care approaches that mitigates gaps in these system factors may prevent death from AMI.
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Affiliation(s)
- Appathurai Balamurugan
- From the Arkansas Department of Health, Little Rock, and the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Martha Phillips
- From the Arkansas Department of Health, Little Rock, and the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - James P Selig
- From the Arkansas Department of Health, Little Rock, and the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Holly Felix
- From the Arkansas Department of Health, Little Rock, and the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kevin Ryan
- From the Arkansas Department of Health, Little Rock, and the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Coventry LL, Bremner AP, van Schalkwyk JW, Hegney DG, Thompson PL. The Effect of Media Campaigns, Patient Characteristics, and Presenting Symptoms on Prehospital Delay in Myocardial Infarction Patients: A Prospective Cohort Study. Heart Lung Circ 2018; 28:1161-1175. [PMID: 30150010 DOI: 10.1016/j.hlc.2018.05.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/09/2018] [Accepted: 05/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Delays in reperfusion therapy for myocardial infarction (MI) are associated with increased mortality and morbidity, and most of this delay is due to delay in patients initiating contact with emergency services. This study assesses the impact of the Australian National Heart Foundation media campaign and identifies patient characteristics and presenting symptoms that may contribute to delay. METHODS This prospective cohort study identified patients with a diagnosis of MI admitted to a single tertiary metropolitan hospital in Perth, Western Australia from July 2013 to January 2014. Patients were interviewed and responses were categorised to determine their reasons for delaying treatment and the impact of mass media campaigns. Delay times were analysed using multivariable linear regression models for the Whole Cohort (all patients admitted to the tertiary hospital, including patients from rural and peripheral hospitals) and the Direct Admission Cohort (patients admitted directly to the tertiary hospital). RESULTS Of 376 patients, 255 patients provided consent, and symptom onset-time was available for 175 patients. While almost two thirds of the cohort was aware of media campaigns, awareness was not associated with decreased prehospital delay. Median delay was 3.9hours for the Whole Cohort and 3.5hours for the Direct Admission Cohort. Delay was associated with being widowed, symptom onset on a weekday compared with weekend, past medical history of MI and coronary artery bypass graft, private compared with ambulance transport to hospital, and lack of symptoms of sweating and weakness. In addition, for the Direct Admission Cohort, age and income were also associated with delay. CONCLUSIONS This study did not find an association between awareness of media campaigns and delay. This study identified important characteristics and presenting symptoms that are associated with delay, and possibly relevant to future media campaigns.
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Affiliation(s)
- Linda L Coventry
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, Australia; School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia.
| | - Alexandra P Bremner
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | | | - Desley G Hegney
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, Australia; Research Division, Central Queensland University, Brisbane, Qld, Australia; School of Nursing, University of Adelaide, SA, Australia
| | - Peter L Thompson
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
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Al-Zaiti SS, Faramand Z, Alrawashdeh MO, Sereika SM, Martin-Gill C, Callaway C. Comparison of clinical risk scores for triaging high-risk chest pain patients at the emergency department. Am J Emerg Med 2018; 37:461-467. [PMID: 29907395 DOI: 10.1016/j.ajem.2018.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/10/2018] [Accepted: 06/07/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many of the clinical risk scores routinely used for chest pain assessment have not been validated in patients at high risk for acute coronary syndrome (ACS). We performed an independent comparison of HEART, TIMI, GRACE, FRISC, and PURSUIT scores for identifying chest pain due to ACS and for predicting 30-day death or re-infarction in patients arriving through Emergency Medical Services (EMS). METHODS AND RESULTS We enrolled consecutive EMS patients evaluated for chest pain at three emergency departments. A reviewer blinded to outcome data retrospectively reviewed patient charts to compute each risk score. The primary outcome was ACS diagnosed during the primary admission, and the secondary outcome was death or re-infarction within 30-days of initial presentation. Our sample included 750 patients (aged 59 ± 17 years, 42% female), of whom 115 (15.3%) had ACS and 33 (4.4%) had 30-day death or re-infarction. The c-statistics of HEART, TIMI, GRACE, FRISC, and PURSUIT for identifying ACS were 0.87, 0.86, 0.73, 0.84, and 0.79, respectively, and for predicting 30-day death or re-infarction were 0.70, 0.73, 0.72, 0.72, and 0.62, respectively. Sensitivity/negative predictive value of HEART ≥ 4 and TIMI ≥ 3 for ACS detection were 0.94/0.98 and 0.87/0.97, respectively. CONCLUSIONS In chest pain patients admitted through EMS, HEART and TIMI outperform other scores for identifying chest pain due to ACS. Although both have similar negative predictive value, HEART has better sensitivity and lower rate of false negative results, thus it can be used preferentially over TIMI in the initial triage of this population.
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Affiliation(s)
- Salah S Al-Zaiti
- Department of Acute & Tertiary Care Nursing, University of Pittsburgh, PA, United States; Department of Emergency Medicine, University of Pittsburgh, PA, United States.
| | - Ziad Faramand
- Department of Acute & Tertiary Care Nursing, University of Pittsburgh, PA, United States; University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
| | - Mohammad O Alrawashdeh
- Department of Acute & Tertiary Care Nursing, University of Pittsburgh, PA, United States; Jordan University of Science and Technology, Irbid, Jordan
| | - Susan M Sereika
- Department of Research & Evaluation, University of Pittsburgh, PA, United States; Department of Biostatistics, University of Pittsburgh, PA, United States
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, PA, United States; University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
| | - Clifton Callaway
- Department of Emergency Medicine, University of Pittsburgh, PA, United States; University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
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Sepehrvand N, Alemayehu W, Kaul P, Pelletier R, Bello AK, Welsh RC, Armstrong PW, Ezekowitz JA. Ambulance use, distance and outcomes in patients with suspected cardiovascular disease: a registry-based geographic information system study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 9:45-58. [PMID: 29652166 DOI: 10.1177/2048872618769872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite guideline recommendations, the majority of patients with symptoms suggestive of acute coronary syndrome do not use emergency medical services to reach the emergency department (ED). The aim of this study was to investigate the factors associated with EMS utilisation and subsequent patient outcomes. METHODS Using administrative data, all patients who presented to an ED in the metropolitan areas of Edmonton and Calgary in the years of 2007-2013 with main ED diagnosis of acute coronary syndrome, stable angina or chest pain were included. The travel distance was estimated using the geographic information system method to approximate the distance between the ED and patient home. The clinical endpoints were the 7-day and 30-day all-cause events (death, re-hospitalisation and repeat ED visit). RESULTS Of 50,881 patients, 30.5% presented by emergency medical services. Patients with older age, female sex, ED diagnosis of acute coronary syndrome, more comorbidities and lower household income were more likely to use emergency medical services to reach the hospital. Longer travel distance was associated with higher emergency medical services use (odds ratio 1.09, 95% confidence interval 1.09-1.10), but it was not a predictor of clinical events. After adjustment for covariates and inverse propensity score weighting, emergency medical services use was associated with a higher risk of 7-day and 30-day clinical events. CONCLUSION Several demographic and clinical features were associated with higher emergency medical services use including geographical variation. Although longer travel distance was shown to be linked to higher emergency medical services use, it was not an independent predictor of patient outcome. This has implications for the design of emergency medical services systems, triage and early diagnosis and treatment options.
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Affiliation(s)
- Nariman Sepehrvand
- Canadian VIGOUR Centre, University of Alberta, Canada.,Department of Medicine, University of Alberta, Canada
| | | | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Canada.,Department of Medicine, University of Alberta, Canada
| | - Rick Pelletier
- Department of Renewable Resources, University of Alberta, Canada
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Canada
| | - Robert C Welsh
- Canadian VIGOUR Centre, University of Alberta, Canada.,Department of Medicine, University of Alberta, Canada.,Mazankowski Alberta Heart Institute, Canada
| | | | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Canada.,Department of Medicine, University of Alberta, Canada.,Mazankowski Alberta Heart Institute, Canada
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Lim IH, Park HJ, Park HY, Yun KH, Wi DH, Lee YH. Clinical Characteristics of Elderly Acute Ischemic Stroke Patients Calling Emergency Medical Services. Ann Geriatr Med Res 2017. [DOI: 10.4235/agmr.2017.21.4.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- In Hwan Lim
- Department of Neurology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science and Regional Cardiocerebrovascular Center, Iksan, Korea
| | - Hyung Jong Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Young Park
- Department of Neurology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science and Regional Cardiocerebrovascular Center, Iksan, Korea
| | - Kyeong Ho Yun
- Department of Cardiovascular Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Dae-Han Wi
- Department of Emergency Medicine, Wonkwang University Sanbon Medical Center, Gunpo, Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine, Wonkwang University School of Medicine and Regional Cardiocerebrovascular Center, Iksan, Korea
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Ma J, Wang J, Zheng W, Zheng J, Wang H, Wang G, Zhang H, Xu F, Chen Y. Usage of ambulance transport and influencing factors in acute coronary syndrome: a cross-sectional study at a tertiary centre in China. BMJ Open 2017; 7:e015809. [PMID: 28827246 PMCID: PMC5629702 DOI: 10.1136/bmjopen-2016-015809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore the choice of transportation mode to hospital in patients with acute coronary syndrome (ACS) and to determine the factors influencing the use of ambulance. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study was conducted in a tertiary and teaching hospital in China. The study was carried out between 24 August 2015 and 24 July 2016. A total of 828 patients with ACS presented at the emergency department (ED) were included. The study population was dichotomised according to their primary mode of transport (ambulance or self-transport) to hospital. Social demographics, cardiovascular history, risk factors, prehospital medications, clinical characteristics and symptom characteristics were collected. Multivariable logistic regression was used to examine the factors associated with ambulance use. RESULTS We found that only 179 (21.6%) patients with ACS chose taking ambulance to hospital. Factors associated with ambulance use were single (OR 1.66, 95% CI 1.07 to 2.57), taking Suxiaojiuxin pills (OR 1.91, 1.31 to 2.80) or nitrates (OR 2.91, 1.70 to 4.99) before going to hospital, diagnosed as ST-elevation myocardial infarction (STEMI) (OR 2.43, 1.45 to 4.05), with persistent symptoms (OR 1.95, 1.33 to 2.86) and symptoms accompanied with vomiting (OR 2.35, 1.19 to 4.62). The patients who had symptoms precipitated or aggravated by exercise (OR 0.37, 0.14 to 0.98) tended to choose self-transport. CONCLUSION The usage of ambulance in patients with ACS presenting to the ED was low in China. Factors like single, taking Suxiaojiuxin pills or nitrates before going to hospital, diagnosed as STEMI, accompanied with vomiting and persistent symptoms were independently associated with ambulance use. Future education programmes should focus on these factors and increase people's knowledge on ACS and the benefits of ambulance use.
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Affiliation(s)
- Jingjing Ma
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Jiali Wang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Wen Zheng
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Jiaqi Zheng
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Hao Wang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Guangmei Wang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - He Zhang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Feng Xu
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Yuguo Chen
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
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Hermans MPJ, Velders MA, Smeekes M, Drexhage OS, Hautvast RWM, Ytsma T, Schalij MJ, Umans VAWM. Call-to-balloon time dashboard in patients with ST-segment elevation myocardial infarction results in significant improvement in the logistic chain. EUROINTERVENTION 2017; 13:e564-e571. [PMID: 27993751 DOI: 10.4244/eij-d-16-00124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Timely reperfusion with primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients is associated with superior clinical outcomes. Aiming to reduce ischaemic time, an innovative system for home-to-hospital (H2H) time monitoring was implemented, which enabled real-time evaluation of ischaemic time intervals, regular feedback and improvements in the logistic chain. The objective of this study was to assess the results after implementation of the H2H dashboard for monitoring and evaluation of ischaemic time in STEMI patients. METHODS AND RESULTS Ischaemic time in STEMI patients transported by emergency medical services (EMS) and treated with pPCI in the Noordwest Ziekenhuis, Alkmaar before (2008-2009; n=495) and after the implementation of the H2H dashboard (2011-2014; n=441) was compared. Median time intervals were significantly shorter in the H2H group (door-to-balloon time 32 [IQR 25-43] vs. 40 [IQR 28-55] minutes, p-value <0.001, FMC-to-balloon time 62 [IQR 52-75] vs. 80 [IQR 67-103] minutes, p-value <0.001, and treatment delay 142 [IQR 103-221] vs. 159 [IQR 123-253] minutes, p-value <0.001). The H2H time dashboard was independently associated with shorter time delays. CONCLUSIONS Real-time monitoring and feedback on time delay with the H2H dashboard improves the logistic chain in STEMI patients, resulting in shorter ischaemic time intervals.
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Affiliation(s)
- Maaike P J Hermans
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
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Impact of Telephone-Based Problem-Solving Treatment on the Use of Medical and Psychological Services in the Military. J Head Trauma Rehabil 2017; 33:E1-E6. [PMID: 28422894 DOI: 10.1097/htr.0000000000000299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore the impact of problem-solving treatment (PST) for mild traumatic brain injury in active duty service members on the use of medical and psychological services. PARTICIPANTS Service members who had a mild traumatic brain injury during their last deployment and enrolled in the CONcussion Treatment After Combat Trauma (CONTACT) study. DESIGN Secondary analysis of a randomized clinical trial. Participants were assigned to telephone-based PST, or e-mailed or mailed education only over the course of 6 months. MAIN MEASURE Self-reported health service utilization from months 4 through 6 and 10 through 12 after initiation of treatment, using the Cornell Service Index. RESULTS In months 4 to 6, participants receiving PST had 6.17 times the odds of an emergency department visit or hospitalization than those receiving education only (95% confidence interval = 1.92-19.8; P value = .0023). These estimates, however, were not significant using a conservative Bonferroni correction (P value threshold < .0014). There were no other significant differences for other medical or psychological services received in months 4 to 6 or 10 to 12. CONCLUSION Telephone-based PST was designed to complement clinical care, and this study showed that it may increase emergency department utilization. Future evaluations of PST with more accurate and complete measures of health service utilization are needed.
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Cartledge S, Finn J, Straney L, Ngu P, Stub D, Patsamanis H, Shaw J, Bray J. The barriers associated with emergency medical service use for acute coronary syndrome: the awareness and influence of an Australian public mass media campaign. Emerg Med J 2017; 34:466-471. [PMID: 28289037 DOI: 10.1136/emermed-2016-206396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/03/2017] [Accepted: 02/15/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Emergency medical services (EMS) transport to hospital is recommended in acute coronary syndrome (ACS) guidelines, but only half of patients with ACS currently use EMS. The recent Australian Warning Signs campaign conducted by the Heart Foundation addressed some of the known barriers against using EMS. Our aim was to examine the influence of awareness of the campaign on these barriers in patients with ACS. METHODS Interviews were conducted with patients admitted to an Australian tertiary hospital between July 2013 and April 2014 with a diagnosis of ACS. Patient selection criteria included: aged 35-75 years, competent to provide consent, English speaking, not in residential care and medically stable. Multivariable logistic regression was used to examine factors associated with EMS use. RESULTS Only 54% of the 199 patients with ACS interviewed used EMS for transport to hospital. Overall 64% of patients recalled seeing the campaign advertising, but this was not associated with increased EMS use (52.0%vs56.9%, p=0.49) or in the barriers against using EMS. A large proportion of patients (43%) using other transport thought it would be faster. Factors associated with EMS use for ACS were: age >65 years, ST-elevation myocardial infarction, a sudden onset of pain and experiencing vomiting. CONCLUSION In medically stable patients with ACS, awareness of the Australian Warning Signs campaign was not associated with increased use of EMS or a change in the barriers for EMS use. Future education strategies could emphasise the clinical role that EMS provide in ACS.
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Affiliation(s)
- Susie Cartledge
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
| | - Lahn Straney
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Phillip Ngu
- Alfred Health, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Victoria, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Victoria, Australia.,Western Health, Victoria, Australia
| | | | - James Shaw
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
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Callachan EL, Alsheikh-Ali AA, Nair SC, Bruijns S, Wallis LA. Outcomes by Mode of Transport of ST Elevation MI Patients in the United Arab Emirates. West J Emerg Med 2017; 18:349-355. [PMID: 28435484 PMCID: PMC5391883 DOI: 10.5811/westjem.2017.1.32593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/09/2017] [Accepted: 01/20/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities. METHODS This multicenter study involved the collection of both retrospective and prospective data from 455 patients admitted to four hospitals in Abu Dhabi. We collected electronic medical records from EMS and hospitals, and conducted interviews with patients in person or via telephone. Chi-square tests and Kruskal-Wallis tests were used to examine differences in variables by mode of transportation. RESULTS Results indicated significant differences in modes of transportation when considering symptom-onset-to-balloon time (p < 0.001), door-to-balloon time (p < 0.001), and health status at six-month and one-year follow-up (p < 0.001). Median times (interquartile range) for patients transported by EMS, private vehicle, or transferred from an outside facility were as follows: symptom-onset-to-balloon time in hours, 3.1 (1.8-4.3), 3.2 (2.1-5.3), and 4.5 (3.0-7.5), respectively; door-to-balloon time in minutes, 70 (48-78), 81 (64-105), and 62 (46-77), respectively. In all cases, EMS transportation was associated with a shorter time to treatment than other modes of transportation. However, the EMS group experienced greater rates of in-hospital events, including cardiac arrest and mortality, than the private transport group. CONCLUSION Our results contribute data supporting EMS transportation for patients with acute coronary syndrome. Although a lack of follow-up data made it difficult to draw conclusions about long-term outcomes, our findings clearly indicate that EMS transportation can speed time to treatment, including time to balloon inflation, potentially reducing readmission and adverse events. We conclude that future efforts should focus on encouraging the use of EMS and improving transfer practices. Such efforts could improve outcomes for patients presenting with STEMI.
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Affiliation(s)
- Edward L Callachan
- University of Cape Town, Department of Surgery, Division of Emergency Medicine, Bellville, South Africa
| | - Alawi A Alsheikh-Ali
- Mohammed Bin Rashid University of Medicine and Health Sciences, College of Medicine, Dubai, United Arab Emirates.,Sheikh Khalifa Medical City, Institute of Cardiac Sciences, Abu Dhabi, United Arab Emirates
| | | | - Stevan Bruijns
- University of Cape Town, Department of Surgery, Division of Emergency Medicine, Bellville, South Africa
| | - Lee A Wallis
- University of Cape Town, Department of Surgery, Division of Emergency Medicine, Bellville, South Africa
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Koyama T, Kashima T, Yamamoto M, Ouchi K, Kotoku T, Mizuno Y. A study of the effect of introduction of JTAS in the emergency room. Acute Med Surg 2017; 4:262-270. [PMID: 29123873 PMCID: PMC5674479 DOI: 10.1002/ams2.266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/04/2017] [Indexed: 11/09/2022] Open
Abstract
Aim The purpose of this study was to better understand the effects of introducing the Japan Triage and Acuity Scale (JTAS) in the emergency room for walk‐in patients. Methods A simple triage was used in Term A (from April 2006 to December 2010, 4 years and 9 months) and the JTAS was introduced in Term B (from January 2011 to September 2015, 4 years and 9 months). The number of patients who had a sudden turn for the worse after arrival in the emergency room and the time between attendance and emergency catheterization (TBAEC) due to acute coronary syndrome were reviewed. Results There were 653 patients in Term A and 626 patients in Term B who were finally diagnosed as having serious causes. There was no significant difference in the frequency of a sudden turn for the worse between the two terms. There were 182 patients in Term A and 167 patients in Term B who underwent emergency catheterization due to acute coronary syndrome. When ST elevation was recognized in the first electrocardiogram, the median time between attendance and medical attention during Term B improved significantly, by 4.5 min. However, there was no significant difference in medians for TBAEC. When ST elevation was not recognized, there was no significant difference between the two terms, neither in terms of median time between attendance and medical attention, nor TBAEC. Conclusion The data suggests that the effects of introducing the JTAS in the emergency room were restrictive in these two aspects.
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Affiliation(s)
- Toru Koyama
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
| | - Takeshi Kashima
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
| | - Motoyoshi Yamamoto
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
| | - Kenjiro Ouchi
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
| | - Takayuki Kotoku
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
| | - Yuta Mizuno
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
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Koifman E, Beigel R, Iakobishvili Z, Shlomo N, Biton Y, Sabbag A, Asher E, Atar S, Gottlieb S, Alcalai R, Zahger D, Segev A, Goldenberg I, Strugo R, Matetzky S. Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients - real-world data from the Acute Coronary Syndrome Israeli Survey. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:497-503. [PMID: 28107026 DOI: 10.1177/2048872616687097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. METHODS Data from the Acute Coronary Survey in Israel registry 2000-2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. RESULTS The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( p<0.001). Independent predictors of mobile intensive care unit use were Killip>1 (odds ratio=1.32, p<0.001), the presence of cardiac arrest (odds ratio=1.44, p=0.02), and a systolic blood pressure <100 mm Hg (odds ratio=2.01, p<0.001) at presentation. Patients arriving via mobile intensive care units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, p<0.001). Among ST-elevation myocardial infarction patients undergoing primary reperfusion, those arriving by mobile intensive care unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120-262) vs 195 (interquartile range 130-333) min, respectively ( p<0.001)). Upon a multivariate analysis, mobile intensive care unit use was the most important predictor in achieving door-to-balloon time <90 min (odds ratio=2.56, p<0.001) and door-to-needle time <30 min (odds ratio=2.96, p<0.001). One-year mortality rates were 10.7% in both groups (log-rank p-value=0.98), however inverse propensity weight model, adjusted for significant differences between both groups, revealed a significant reduction in one-year mortality in favor of the mobile intensive care unit group (odds ratio=0.79, 95% confidence interval (0.66-0.94), p=0.01). CONCLUSIONS Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.
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Affiliation(s)
- Edward Koifman
- 1 Heart Institute, Chaim Sheba Medical Center, Israel.,2 Sackler School of Medicine, Tel Aviv University, Israel
| | - Roy Beigel
- 1 Heart Institute, Chaim Sheba Medical Center, Israel.,2 Sackler School of Medicine, Tel Aviv University, Israel
| | - Zaza Iakobishvili
- 2 Sackler School of Medicine, Tel Aviv University, Israel.,3 Cardiology Department, Rabin Medical Center, Israel
| | - Nir Shlomo
- 4 Israeli Association for Cardiovascular Trials, Israel
| | - Yitschak Biton
- 1 Heart Institute, Chaim Sheba Medical Center, Israel.,2 Sackler School of Medicine, Tel Aviv University, Israel
| | - Avi Sabbag
- 1 Heart Institute, Chaim Sheba Medical Center, Israel.,2 Sackler School of Medicine, Tel Aviv University, Israel
| | - Elad Asher
- 1 Heart Institute, Chaim Sheba Medical Center, Israel.,2 Sackler School of Medicine, Tel Aviv University, Israel
| | - Shaul Atar
- 5 Department of Cardiovascular Medicine, Galilee Medical Center, Nahariya, Israel.,6 Faculty of Medicine of the Galilee, Bar-Ilan University, Sefad, Israel
| | - Shmuel Gottlieb
- 7 Department of Cardiology, Shaare Zedek Medical Center, Israel
| | - Ronny Alcalai
- 8 Heart institute Hadassah, Hebrew University Medical Center and School, Israel
| | - Doron Zahger
- 9 Department of Cardiology, Soroka University Medical Center, Israel.,10 Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Amit Segev
- 1 Heart Institute, Chaim Sheba Medical Center, Israel.,2 Sackler School of Medicine, Tel Aviv University, Israel
| | - Ilan Goldenberg
- 1 Heart Institute, Chaim Sheba Medical Center, Israel.,2 Sackler School of Medicine, Tel Aviv University, Israel.,4 Israeli Association for Cardiovascular Trials, Israel
| | | | - Shlomi Matetzky
- 1 Heart Institute, Chaim Sheba Medical Center, Israel.,2 Sackler School of Medicine, Tel Aviv University, Israel.,4 Israeli Association for Cardiovascular Trials, Israel
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Nehme Z, Cameron PA, Akram M, Patsamanis H, Bray JE, Meredith IT, Smith K. Effect of a mass media campaign on ambulance use for chest pain. Med J Aust 2017; 206:30-35. [DOI: 10.5694/mja16.00341] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/15/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Ziad Nehme
- Ambulance Service of Victoria, Melbourne, VIC
- Monash University, Melbourne, VIC
| | - Peter A Cameron
- Monash University, Melbourne, VIC
- Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University, Ballarat, VIC
| | - Muhammad Akram
- Monash University, Melbourne, VIC
- Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University, Ballarat, VIC
| | | | | | | | - Karen Smith
- Ambulance Service of Victoria, Melbourne, VIC
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Kodama N, Nakamura T, Yanishi K, Nakanishi N, Zen K, Yamano T, Shiraishi H, Shirayama T, Shiraishi J, Sawada T, Kohno Y, Kitamura M, Furukawa K, Matoba S. Impact of Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction Who Arrived by Self-Transport ― Acute Myocardial Infarction-Kyoto Multi-Center Risk Study Group ―. Circ J 2017. [DOI: 10.1253/circj.cj-17-0083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naotoshi Kodama
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Kenji Yanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital
| | | | - Yoshio Kohno
- Department of Cardiology, Kyoto First Red Cross Hospital
| | | | | | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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48
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Santos RCDOD, Goulart AC, Kisukuri ALX, Brandão RM, Sitnik D, Staniak HL, Bittencourt MS, Lotufo PA, Bensenor IM, Santos IDS. Time-To-Treatment of Acute Coronary Syndrome and Unit of First Contact in the ERICO Study. Arq Bras Cardiol 2016; 107:323-330. [PMID: 27849262 PMCID: PMC5102478 DOI: 10.5935/abc.20160138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/28/2016] [Indexed: 12/20/2022] Open
Abstract
Background To the best of our knowledge, there are no studies evaluating the influence
of the unit of the first contact on the frequency and time of
pharmacological treatment during an acute coronary syndrome (ACS) event. Objectives The main objective was to investigate if the unit of first contact influenced
the frequency and time of aspirin treatment in the Strategy of Registry of
Acute Coronary Syndrome (ERICO) study. Methods We analyzed the pharmacological treatment time in 830 ERICO participants -
700 individuals for whom the hospital was the unit of first contact and 130
who initially sought primary care units. We built logistic regression models
to study whether the unit of first contact was associated with a treatment
time of less than three hours. Results Individuals who went to primary care units received the first aspirin dose in
those units in 75.6% of the cases. The remaining 24.4% received aspirin at
the hospital. Despite this finding, individuals from primary care still had
aspirin administered within three hours more frequently than those who went
to the hospital (76.8% vs 52.6%; p<0.001 and 100% vs. 70.7%; p=0.001 for
non ST-elevation ACS and ST-elevation myocardial infarction, respectively).
In adjusted models, individuals coming from primary care were more likely to
receive aspirin more quickly (odds ratio: 3.66; 95% confidence interval:
2.06-6.51). Conclusions In our setting, individuals from primary care were more likely to receive
aspirin earlier. Enhancing the ability of primary care units to provide
early treatment and safe transportation may be beneficial in similar
settings.
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Affiliation(s)
| | - Alessandra Carvalho Goulart
- Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | | | - Rodrigo Martins Brandão
- Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Debora Sitnik
- Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Henrique Lane Staniak
- Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Marcio Sommer Bittencourt
- Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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49
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Kaul P, Welsh RC, Liu W, Savu A, Weiss DR, Armstrong PW. Temporal and Provincial Variation in Ambulance Use Among Patients Who Present to Acute Care Hospitals With ST-Elevation Myocardial Infarction. Can J Cardiol 2016; 32:949-55. [DOI: 10.1016/j.cjca.2015.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 11/24/2022] Open
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50
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Factors Associated With Emergency Services Use by Patients With Recurrent Myocardial Infarction: From the Monitoring Trends and Determinants in Cardiovascular Disease/Cooperative Health Research in the Region of Augsburg Myocardial Infarction Registry. J Cardiovasc Nurs 2016; 32:409-418. [PMID: 27428355 DOI: 10.1097/jcn.0000000000000359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although emergency medical services (EMS) use is the recommended mode of transport in case of acute coronary symptoms, many people fail to use this service. OBJECTIVE The objective of this study was to determine factors associated with EMS use in a population-based sample of German patients with recurrent acute myocardial infarction (AMI). METHODS The sample consisted of 998 persons with a first and recurrent AMI, recruited from 1985 to 2011. Logistic regression modeling adjusted for sociodemographic, situational, and clinical variables, previous diseases, and presenting AMI symptoms was applied. RESULTS Emergency medical services was used by 48.8% of the patients at first, and 62.6% at recurrent AMI. In first AMI, higher age, history of hyperlipidemia, ST-segment elevation AMI, more than 4 presenting symptoms, symptom onset in daytime, and later year of AMI were significantly related with EMS use. Pain in the upper abdomen and pain between the shoulder blades were significantly less common in EMS users. In recurrent AMI, EMS use at first AMI, presence of any other symptom except chest pain, ST-segment elevation myocardial infarction, and later year of AMI were significantly related with EMS use. Significant predictors of EMS use in recurrent AMI in patients who failed to use EMS at first AMI were unmarried, experience of any symptom except chest symptoms at reinfarction, bundle branch block (first AMI), any in-hospital complication (first AMI), longer duration between first and recurrent AMI, and later year of reinfarction. CONCLUSIONS Patients with AMI and their significant others may profit by education about the benefits of EMS use.
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