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Predictors of Ambulance Transport in Patients with ST-Elevation Myocardial Infarction

Published online by Cambridge University Press:  13 June 2012

Tara M. Scherer ,
Stephan Russ ,
Cathy A. Jenkins ,
Ian D. Jones ,
Corey M. Slovis ,
Brittany L. Cunningham  and
Tyler W. Barrett
Tara M. Scherer
Affiliation:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee USA
Stephan Russ
Affiliation:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee USA
Cathy A. Jenkins
Affiliation:
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee USA
Ian D. Jones
Affiliation:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee USA
Corey M. Slovis
Affiliation:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee USA
Brittany L. Cunningham
Affiliation:
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee USA
Tyler W. Barrett*
Affiliation:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee USA
*
Correspondence: Tyler W. Barrett, MD, MSCI Department of Emergency Medicine Vanderbilt University Medical Center 703 Oxford House Nashville, TN 37232-4700 USA E-mail tyler.barrett@vanderbilt.edu
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Abstract

Introduction

Despite intense public awareness campaigns, many patients with ST-elevation myocardial infarction (STEMI) do not utilize Emergency Medical Services (EMS) transportation to the Emergency Department (ED). Predictors for mode of transport by EMS versus private vehicle in patients with an acute STEMI were investigated.

Hypothesis

It was hypothesized that patient characteristics, specifically older age, male sex, and a history of a prior cardiac intervention, would be associated with a higher likelihood of EMS utilization.

Methods

A retrospective, observational cohort study was performed for all STEMI patients treated from April 1, 2007 through June 30, 2010 at an urban, academic ED with 24-hour cardiac catheterization available. Multivariable analyses with predetermined predictors (age, sex, prior cardiac intervention, weekend/evening arrival) were performed to investigate associations with mode of transport. Door-to-balloon (D2B) times were calculated.

Results

Of the 209 STEMI patients, 11 were excluded, leaving 198 for analysis. Median age was 60 years (IQR: 53-70), 138 (70%) arrived by private vehicle, and 60 (30%) by EMS. The primary analysis did not identify significant predictors for EMS, but a post-hoc model found that private insurance (OR 0.18; 95% CI, 0.07-0.45) was associated with fewer EMS transports. Although not statistically significant due to the great variability in time of arrival for STEMI patients transported by private vehicle, EMS transports had shorter D2B times. During business hours and weekend/evenings, EMS had D2B times of 50 (IQR: 42-61) and 58 minutes (IQR: 47-63), respectively, while private vehicle transports had median D2B times of 62 (IQR: 50-74) and 78 minutes (IQR: 66-106).

Conclusion

No associations between mode of transport and patient age, sex, weekend/evening presentation and history of a prior cardiac intervention were identified. Privately insured patients were less likely to use EMS when experiencing a STEMI. More effective ways are needed to educate the public on the importance of EMS activation when one is concerned for acute coronary syndrome.

Scherer TM, Russ S, Jenkins CA, Jones ID, Slovis CM, Cunningham BL, Barrett TW. Predictors of ambulance transport in patients with ST-elevation myocardial infarction. Prehosp Disaster Med. 2012;27(3):1-5.

Keywords

ambulanceEmergency Medical Servicesforecastingmyocardial infarctionpublic health
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 3 , June 2012 , pp. 226 - 230
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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References

1. Antman, E, Anbe, D, Armstrong, P, et al. . ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines on the Management of Patients with Acute Myocardial Infarction). Circulation. 2004;110(9):588-636.Google Scholar
2. Lambert, L, Brown, K, Segal, E, et al. . Association between timeliness of reperfusion therapy and clinical outcomes in ST-elevation myocardial infarction. JAMA. 2010;303(21):2148-2155.CrossRefGoogle ScholarPubMed
3. Nallamothu, B, Fox, KA, Kennelly, BM, et al. . Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events. Heart. 2007;93(12):1552-1555.CrossRefGoogle ScholarPubMed
4. Rathore, SS, Curtis, JP, Nallamothu, BK, et al. . Association of door-to-balloon time and mortality in patients > or =65 oryears with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol. 2009;104(9):1198-1203.CrossRefGoogle ScholarPubMed
5. Brown, JP, Mahmud, E, Dunford, JV, et al. . Effect of prehospital 12-lead electrocardiogram on activation of the cardiac catheterization laboratory and door-to-balloon time in ST-segment elevation acute myocardial infarction. Am J Cardiol. 2008;101(2):158-161.CrossRefGoogle ScholarPubMed
6. Ting, HH, Krumholz, HM, Bradley, EH, et al. . American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Clinical Cardiology. Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology. Circulation. 2008;118(10):1066-1079.CrossRefGoogle ScholarPubMed
7. McCabe, JM, Patel, QB, Armstrong, E, Garg, S, Stein, JC, Ganz, P. Ambulance use or its lack -- impact on triage of patients with ST-elevation myocardial infarctions by emergency physicians. J Am Coll Cardiol. 2011;57:1221.CrossRefGoogle Scholar
8. Thuresson, M, Jarlöv, MB, Lindahl, B, et al. . Factors that influence the use of ambulance in acute coronary syndrome. Am Heart J. 2008;156(1):170-176.CrossRefGoogle ScholarPubMed
9. Peterson, ED, Roe, MT, Rumsfeld, JS, et al. . A call to ACTION (Acute Coronary Treatment and Intervention Outcomes Network): a national effort to promote timely clinical feedback and support continuous quality improvement for acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2009;2(5):491-499.CrossRefGoogle Scholar
10. Steyerberg, EW. Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating. New York, NY: Springer; 2009:50.CrossRefGoogle Scholar