The impact of emergency medical services in acute heart failure

Pt, Harjola; Boyd, James; Tarvasmäki, Tuukka; Mattila, J.; Koski, Reijo; Kuisma, Markku; Harjola, Veli‐Pekka

doi:10.1016/j.ijcard.2017.01.017

Cited by 8 publications

(22 citation statements)

References 25 publications

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“…Considering these two findings, it is important that EMD provides the most appropriate EMS unit for a patient with suspected AHF. However, the reported proportion of AHF patients calling to dispatching centres varies from 11% in Finland to 53% of cases in Spain, and less than one‐third of AHF patients are managed by an ALS unit . The SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure) explored factors associated with EMS unit provision by EMD and found out that ALS unit assignment was well related to the severity of AHF…”

Section: Discussionmentioning

confidence: 99%

“…However, the reported proportion of AHF patients calling to dispatching centres varies from 11% in Finland 3 to 53% of cases in Spain, 4 and less than one-third of AHF patients are managed by an ALS unit. 3,4 The SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure) explored factors associated with EMS unit provision by EMD and found out that ALS unit assignment was well related to the severity of AHF. 4,22 In our survey, most of the EMS regions had a specific management protocol for AHF.…”

Section: Discussionmentioning

confidence: 99%

“…The routine AHF management includes 12‐lead electrocardiogram (ECG) recording, vital sign monitoring, option for treatment with supplementary oxygen, non‐invasive ventilation (NIV), and administration of IV diuretics and vasodilators . However, the administration of pre‐hospital medication seems scarce . Moreover, earlier studies suggest that it might be difficult for EMS personnel to differentiate AHF from other underlying causes of dyspnoea especially when the diagnosis is based only on patient's medical history and clinical signs and symptoms …”

Section: Introductionmentioning

confidence: 99%

“…1,2 From 11-53% of AHF patients arrive to the ED by ambulance. [3][4][5] While the prognosis of AHF patients' remains poor, [6][7][8][9] the importance of early phase and pre-hospital management by emergency medical services (EMS) has been recently underlined. [10][11][12][13] Traditionally, EMS units are categorized by their resources for diagnosis and care and the level of personnel.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 However, the administration of pre-hospital medication seems scarce. 3,4,13,14 Moreover, earlier studies suggest that it might be difficult for EMS personnel to differentiate AHF from other underlying causes of dyspnoea [14][15][16][17] especially when the diagnosis is based only on patient's medical history and clinical signs and symptoms. 18,19 Illustrative data on the possibilities of EMS to treat and diagnose AHF in the pre-hospital setting in accordance with the guidelines are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Pre‐hospital management protocols and perceived difficulty in diagnosing acute heart failure

Miró

Martín‐Sánchez

et al. 2019

ESC Heart Failure

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Aim To illustrate the pre‐hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre‐hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre‐hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point‐of‐care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST‐elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12‐lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point‐of‐care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non‐invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST‐elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre‐hospital conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pre‐hospital management protocols and perceived difficulty in diagnosing acute heart failure

Miró

Martín‐Sánchez

et al. 2019

ESC Heart Failure

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Predictors of emergency medical services use by adults with heart failure; 2009–2017

et al. 2020

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Background: Heart failure (HF) necessitates frequent transport by emergency medical services (EMS), but few studies have been conducted to evaluate predictors of EMS use and of multiple EMS transports that are amenable to intervention. Objectives: To characterize prehospital clinical status of community-dwelling adults with reported HF who used EMS across 8 years and to evaluate predictors of EMS use and multiple EMS transports. Methods: Data were from a database in a large Midwestern county. Descriptive statistics, logistic and negative binomial regression were used for analysis. Results: EMS transports were evaluated for 6582 adults with 16,905 transports. The most common chief complaints were respiratory problems, feeling sick, and chest pain. Shortness of breath, chest pain, level of consciousness, age, gender, race, and hospital site predicted multiple transports. Conclusions: Clinicians need to educate patients with HF about ways to manage shortness of breath and chest pain and when to activate EMS.

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Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure: Insights from the EAHFE Spanish registry

Miró

Llorens

Freund

et al. 2021

International Journal of Cardiology

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The impact of emergency medical services in acute heart failure

Cited by 8 publications

References 25 publications

Pre‐hospital management protocols and perceived difficulty in diagnosing acute heart failure

Pre‐hospital management protocols and perceived difficulty in diagnosing acute heart failure

Predictors of emergency medical services use by adults with heart failure; 2009–2017

Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure: Insights from the EAHFE Spanish registry

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