Abstract 16109: Under-utilization of Emergency Medical Service Transport Among Contemporary Patients with ST Elevation Myocardial Infarction: Findings from the National Cardiovascular Data Registry ACTION — Get With The Guidelines
Background: Guidelines recommend expedited transport via emergency medical services (EMS) to facilitate early triage and reperfusion of patients with ST-elevation myocardial infarction (STEMI). Yet for a number of reasons, many patients still present to the hospital via self-transportation.
Methods: We examined mode of transport for 37,634 patients presenting with STEMI to 372 hospitals in ACTION Registry-GWTG between Jan 07 and Sep 09. Patient home zip codes were collected starting Jul 08 for 18,069 patients. Using logistic regression modeling, we examined independent clinical and sociodemographic factors derived from the case report form and home zip code that are associated with patient self vs. EMS transportation.
Results: Self-transport occurred in 40% of STEMI patients. Older patients and those living further from the hospital were more likely to use EMS transport, while patients of Hispanic ethnicity and male gender were more likely to self-transport (Table). Clinically, patients with lower blood pressure and heart failure symptoms were more likely to activate EMS, while patients with prior CABG were more likely to self transport. Income and education level did not appear to be associated with the mode of transportation. Self-transported patients had longer delays from symptom onset to hospital arrival (median 120 vs. 89 min, p<0.0001) and longer delays to reperfusion (median door-to-balloon time 76 vs. 63 min, p<0.0001, median door-to-needle time 29 vs. 23 min, p<0.0001).
Conclusions: EMS transportation to the hospital is under-utilized among contemporary STEMI patients and failure to use EMS is associated with delays in treatment. Community education efforts should be tailored to the sociodemographic groups that underutilize EMS, and should be integrated with system-wide strategies designed to improve reperfusion care.
- © 2010 by American Heart Association, Inc.