2021
DOI: 10.1136/emermed-2020-210522
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Predictors of hospital prenotification for STEMI and association of prenotification with outcomes

Abstract: BackgroundDelay to reperfusion in ST-elevation myocardial infarction (STEMI) is detrimental, but can be minimised with prehospital notification by ambulance to the treating hospital. We aimed to assess whether prenotification was associated with improved first medical contact to balloon times (FMC-BT) and whether this resulted in better clinical outcomes. We also aimed to identify factors associated with use of prenotification.MethodsThis was a retrospective study of prospective Victorian Cardiac Outcomes Regi… Show more

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Cited by 7 publications
(9 citation statements)
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“…Previously published literature regarding the impact of prehospital activation of STEMI patients are consistent with the findings of this study with the consensus that there are significantly improved STEMI performance metrics [8,9,11,12,15,22,23]. Whilst the literature is predominantly supportive of lower mortality associated with prehospital activation strategies [8,[12][13][14][15], recently published data was suggestive of no mortality benefit with a prehospital notification strategy [16,17]. The published literature from Australia regarding mortality is mixed with national data showing lower mortality with ambulance transported patients compared to those who self-present in the GRACE and CONCORDANCE registries [24].…”
Section: Discussionsupporting
confidence: 88%
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“…Previously published literature regarding the impact of prehospital activation of STEMI patients are consistent with the findings of this study with the consensus that there are significantly improved STEMI performance metrics [8,9,11,12,15,22,23]. Whilst the literature is predominantly supportive of lower mortality associated with prehospital activation strategies [8,[12][13][14][15], recently published data was suggestive of no mortality benefit with a prehospital notification strategy [16,17]. The published literature from Australia regarding mortality is mixed with national data showing lower mortality with ambulance transported patients compared to those who self-present in the GRACE and CONCORDANCE registries [24].…”
Section: Discussionsupporting
confidence: 88%
“…Implementation of several prehospital strategies both locally and internationally such as the Pre-Act initiative have demonstrated reductions in prehospital delays, further reductions in DTB time and total ischaemic time, and reduced false positive catheterisation laboratory (CCL) activations when protocol driven prehospital STEMI pathways are implemented [6][7][8][9][10][11]. The impact of prehospital notification of STEMI and prehospital activation of the CCL on mortality however remains mixed with either lower [7,8,[12][13][14][15] or equivalent [16,17] outcomes reported both across Australia and internationally. The Australian Acute Coronary Syndrome guidelines recommend primary PCI as the preferred reperfusion strategy if it can be performed within 90 minutes of first medical contact (FMC) [18] yet do not specify prehospital notification of STEMI by paramedics and/or prehospital activation of the CCL as strategies for achieving performance targets.…”
Section: Introductionmentioning
confidence: 99%
“…Blusztein et al identified male gender as an independent predictor of pre-notification for STEMI. 27 Lin et al found that female patients were less likely to receive EMS prenotification for stroke but also identified higher likelihood of EMS prenotification for younger patients and significant ethnic disparities in prenotification, with adjusted odds ratio of pre-alert for black patients of 0.94 (CI0.92-0.97) compared with white patients. 28 Sheppard et al did not identify any statistically different racial or sex differences in stroke pre-alerting, which could be due to the small overall sample (n=271).…”
Section: Discussionmentioning
confidence: 99%
“…Major trauma constituted under 2% of pre-alerts, although this rose to 4% when incorporating trauma/head injury. 17 (11,24) 14 (9,21) 17 (11,24) 16 (11,23) 12 (9,18) 16 (11,23) 18 (12,27) 16 (10,23) 18 (…”
Section: Resultsmentioning
confidence: 99%
“…Blusztein et al identi ed male sex as an independent predictor of pre-noti cation for STEMI. 27 Lin et al found that female patients were less likely to receive EMS prenoti cation for stroke but also identi ed higher likelihood of EMS prenoti cation for younger patients, and signi cant ethnic disparities in prenoti cation, with an adjusted odds ratio of pre-alert for black patients of 0.94 (CI0.92-0.97) compared with white patients. 28 Sheppard et al did not identify any statistically different racial or sex differences in stroke pre-alerting, which could be due to the small overall sample (n = 271).…”
Section: Discussionmentioning
confidence: 99%