Abstract P85: Prehospital Transport of Patients With Acute Heart Failure: Prognostic Significance of Delay in Hospital Arrival
Background - The objective of this registry-based study was to examine the use of emergency medical service in metropolitan Tokyo among acute heart failure (AHF) patients. Recently, due to shortage of ER physicians, delayed transport time has become a major problem in Japan. We sought to assess the relationship between prehospital transportation time and the acute outcome in AHF patients.
Methods - Tokyo CCU Network Database (TCND) prospectively collected information on patients who were emergently admitted to acute cardiac care facilities during 2005 and 2007 from 62 participating hospitals in Tokyo metropolitan area. We analyzed records of 1109 AHF patients transported to medical centers via ambulance. AHF was defined as a rapid onset or change in the signs and symptoms of HF, resulting in a need for urgent therapy. Patients with ACS were excluded from this analysis. Logistic regression analysis was performed to calculate the risk-adjusted in-hospital mortality.
Results -The patients were predominantly elderly (76.1±11.5) and male (52.9%). The overall in-hospital mortality rate was 7.6%. Median time interval between 911 call and the EMS arrival was 64 (interquartile range [IQ] 26–205) minutes, and between EMS arrival and the ER was 92 (IQ 56–231) minutes. Risk-adjusted mortality did not correlate with the time interval from between 911 call to and the EMS arrival (Call-to-EMS Time), but the mortality became higher as the time interval from EMS arrival to the ER (EMS-to-Door Time) increases (Table⇓). Those who took more than 45 minutes to arrive at medical centers were at the highest risk for in-hospital mortality (OR 1.93, 95%CI 1.01–3.70).
Conclusion - EMS-to-Door Time correlated with risk-adjusted mortality and effort towards reducing the EMS transfer time should be implemented to improve outcomes in AHF patients.