The influence of travelling to hospital by ambulance on reperfusion time and outcomes for patients with STEMI

Abstract

In Australia, an estimated 12.7% of patients with ST-elevation myocardial infarction (STEMI) die or have recurrent myocardial infarctions within 30 days of diagnosis. 1 Prompt reperfusion reduces morbidity and mortality, and guidelines consequently aim to minimise the time between symptom onset and reperfusion. [1][2][3] Patients with chest pain may arrange their own transport to an emergency department or travel by ambulance. The risk period is shorter for patients without access to a defibrillator when they travel by ambulance, and they receive initial management more promptly. In Australia, only one in two patients with STEMI calls an ambulance. 4 Characterising patients less likely to call an ambulance would inform targeted public health efforts to improve this situation.We analysed data contributed by 43 hospitals across Australia to the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE) 5 for patients with confirmed STEMI who presented to these hospitals during 23 February 2009 -31 December 2017. We excluded patients who experienced out-of-hospital cardiac

Impact of a mass media campaign on presentations and ambulance use for acute coronary syndrome

“…Second, we were unable to examine the clinical impact of increased EMS use with the available data in this study. However, previous research has found EMS use is associated with shorter times to reperfusion, 4 22 and our previous research found an association between the campaign period and (1) shorter prehospital delay times 8 and (2) a decrease in the incidence of out-of-hospital cardiac arrest in Victoria. 14 Finally, our study used an ED administrative dataset not designed for research, which may be subject to coding errors.…”

“…2 However, only 40%-60% of patients with ACS arrive to the hospital by EMS. [3][4][5] In the mid-2000s, the National Heart Foundation of Australia (NHFA) recognised the need to improve EMS use for ACS in Australia. 6 At that time, the barriers to EMS use were ignoring/denying symptoms, embarrassment and preference to see a local doctor before presenting to the hospital.…”

Patient Characteristics, Risk Factors, and Disease Outcomes in Young Adults With St-Elevation Myocardial Infarction: Insights From The Kermanshah Acute Coronary Syndrome Registry

“…This rate is alarmingly low and consistent with previous studies in Iran; Seyed Mohammadzad et al ( 2010) reported that only 15% of patients with MI admissions in the city of Urmia, Iran arrived at the hospital by ambulance. This rate is even lower than 17% reported by a study conducted in the Middle East [31], while in the United Kingdom (UK) about two-third of all AMI patients [32], in Australia 58.4% [33], and in New Zealand 73% are transferred to hospital by ambulance. A lack of knowledge about the ambulance services and symptoms of heart attack was identi ed as signi cant barriers to using ambulance services in Iran (Seyed Mohammadzadeh et al, 2010).…”

Prehospital activation of the cardiac catheterisation laboratory in ST-segment elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PCI)

“…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]. More recent data from Victoria however highlighted lower mortality with patients who self-presented compared to ambulance transported patients, however there were significantly greater comorbidities, higher rates of cardiogenic shock and mechanical ventricular support in the ambulance transported groups in this cohort study [17].…”