First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study

Abstract

ObjectiveIt is unknown into what extent patients with ST-elevation myocardial infarction (STEMI) utilise a joint service number (Swedish Healthcare Direct, SHD) as first medical contact (FMC) instead of Emergency Medical Services (EMS) and how this impact time to diagnosis. We aimed to (1) describe patients’ FMC; (2) find explanatory factors influencing their FMC (ie, EMS and SHD) and (3) explore the time interval from symptom onset to diagnosis.SettingMulticentred study, Sweden.MethodsCross-sectional, enrolling patients with consecutive STEMI admitted within 24 h from admission.ResultsWe included 109 women and 336 men (mean age 66±11 years). Although 83% arrived by ambulance to the hospital, just half of the patients (51%) called EMS as their FMC. Other utilised SHD (21%), contacted their primary healthcare centre (14%), or went directly to the emergency room (14%). Reasons for not contacting EMS were predominantly; (1) my transport mode was faster (40%), (2) did not consider myself sick enough (30%), and (3) it was easier to be driven or taking a taxi (25%). Predictors associated with contacting SHD as FMC were female gender (OR 1.92), higher education (OR 2.40), history of diabetes (OR 2.10), pain in throat/neck (OR 2.24) and pain intensity (OR 0.85). Predictors associated with contacting EMS as FMC were history of MI (OR 2.18), atrial fibrillation (OR 3.81), abdominal pain (OR 0.35) and believing the symptoms originating from the heart (OR 1.60). Symptom onset to diagnosis time was significantly longer when turning to the SHD instead of the EMS as FMC (1:59 vs 1:21 h, p<0.001).ConclusionsUsing other forms of contacts than EMS, significantly prolong delay times, and could adversely affect patient prognosis. Nevertheless, having the opportunity to call the SHD might also, in some instances, lower the threshold for taking contact with the healthcare system, and thus lowers the number that would otherwise have delayed even longer.

Delayed Care and Mortality Among Women and Men With Myocardial Infarction

“…Our data indicate no significant difference among the rates of women and men using EMS. Similar data on the use of EMS have been reported in the United States and Sweden . Contrary to expectations, women showed significantly higher rates of admission to primary PCI‐capable hospitals; however, prehospital delays were still greater among women.…”

“…Similar data on the use of EMS have been reported in the United States and Sweden. 43,44 Contrary to expectations, women showed significantly higher rates of admission to primary PCI-capable hospitals; however, prehospital delays were still greater among women. These findings underscore the need to improve the management of female patients, even at the EMS centers, perhaps by improving the use of prehospital 12-lead ECG for early identification of STEMI.…”

Impact of preprocedural TIMI flow on clinical outcome in low‐risk patients with ST‐elevation myocardial infarction: Results from the ATLANTIC study

“…6,7 However, the short time until treatment of patients in the ATLANTIC study may not be representative of daily clinical practice. 8,9 In agreement with previously published data, about 65% of the patients had TIMI flow 0/1 in the infarct vessel and 15-20% had TIMI flow 2 or 3. 10-12 Higuma et al 13 showed that greater lipid volume detected by optical coherence tomography and larger vessel size and plaque area detected by intravascular ultrasound are associated with reduced pre-PCI TIMI flow in STEMI patients.…”

“…Furthermore, the median time from onset of symptoms to first balloon inflation was shorter (159 min) than in other STEMI trials . However, the short time until treatment of patients in the ATLANTIC study may not be representative of daily clinical practice …”

Bystander CPR: New aspects of CPR training among students and the importance of bystander education level on survival

“…[148][149][150] Timely recognition of symptoms and early call for help are crucial to the outcome; CA can be prevented and injuries reduced. 145,148,151 Use of online learning platforms is a fast-growing technology trend. 152 Sweden is in third place in the world for the use of the internet among individuals and companies; 93% of young people aged 12-15 years use the internet daily.…”