Factors associated with longer time to treatment in the care of patients transported by emergency medical services for suspected acute coronary syndromes and ST-segment elevation myocardial infarction.
treatment of acute coronary syndromes (ACS) is important, but the causes of delay in
emergency medical services (EMS) care of ACS are not well understood. We conducted a
cohort study of data from a multicenter randomized controlled trial of EMS treatment of
people calling 9-1-1 for symptoms suggesting ACS using hierarchical multiple regression
of elapsed time and the presence ... read moreor absence of delay. A total of 54,230 individuals aged
18 or older called 9-1-1 and had an out-of-hospital electrocardiogram (ECG) performed;
871 were included in the trial for presumed ACS, 303 of whom had STEMI and percutaneous
coronary intervention. Median times from EMS arrival to ECG were 15 minutes among all
participants, 11 minutes in those with presumed ACS, and 10 minutes for those with
STEMI. Median on-scene times were 20 minutes for those with presumed ACS, and 16 minutes
for those with STEMI. Women had longer time from EMS arrival to ECG (7% among all
participants, 12% among those with presumed ACS, and 20% among those with STEMI) and
on-scene times (9% with presumed ACS, and 12% with STEMI). Older individuals had longer
times (among those with presumed ACS; EMS to ECG 8%, on-scene time 10%). Members of
minorities and those without chest pain had longer time from EMS arrival to ECG (among
participants with presumed ACS, 13% and 16% compared to their respective counterparts).
Women and older individuals also had longer hospital and total times (hospital arrival
to balloon 10% and 13%, medical contact to balloon inflation 9% and 18%, symptom onset
to balloon inflation 18% and 13%, respectively). Weekend and night presentations were
only associated with longer hospital times (hospital arrival to balloon inflation 31%
and 24%, medical contact to balloon inflation 19% and 32%, respectively; all p values
< 0.05). Hospital arrival to balloon inflation was double the time in EMS care (62
vs. 30 minutes) for participants with STEMI. We found delays throughout the entire
spectrum of care, which resulted in larger magnitude differences in total times for
women and older individuals. A comprehensive approach to reduce delays is
Thesis (M.S.)--Tufts University, 2013.
Submitted to the Dept. of Clinical & Translational Science.
Advisors: Harry Selker, and Joni Beshansky.
Committee: Robin Ruthazer.
Keyword: Medicine.read less