Abstract 16299: Rural-Urban Disparities in Emergency Medical Services Utilization for ST-Elevation Myocardial Infarction (STEMI)
Introduction: National guidelines recommend pre-hospital ambulance triage of ST-elevation myocardial infarction (STEMI) patients to PCI hospitals. Emergency medical services (EMS) continue to be underutilized.
Methods: Using a comprehensive prospective regional STEMI program database, we evaluated demographic information and clinical outcomes of STEMI patients based on EMS utilization and the size of the community where the patient initially presented. Community sizes were defined as urban (PCI Center/Metropolitan core), small city (population 10,000 to 49,999), and rural (population < 10,000).
Results: From March 2003 to August 2013, 3,854 consecutive STEMI patients presented to the tertiary PCI hospital within the regional STEMI system, including 960 (24.9%) admitted from the urban center, 1,737 (45.1%) transferred from a small city and 1,157 (30.0%) from a rural community. EMS utilization was significantly higher in the urban center compared to small and rural communities (Table 1). In all three communities, patients age ≥ 65 were more likely to use EMS compared to younger patients. In small cities and rural areas, EMS utilization was 21% and 44% higher for women than men, respectively. This trend was further magnified in rural areas for patients with age < 65 as EMS utilization was 60% higher in women than men. Median D2B times were shorter in all 3 regions with EMS utilization; urban (51 vs. 65 minutes), small city (91 vs. 97 minutes), and rural (117 vs. 121 minutes; p<0.01 for all).
Conclusions: A significant urban-rural disparity exists for EMS utilization. EMS utilization is also influenced by both age and gender. Given the known benefits of EMS utilization, targeted education strategies seem warranted.
Author Disclosures: R.F. Garberich: None. R. Shah: None. D.M. Larson: None. S. Sharkey: None. J.H. Traverse: Research Grant; Modest; NHLBI. Research Grant; Significant; modest. P. Sorajja: None. D. Hildebrandt: None. T.D. Henry: None.
- © 2014 by American Heart Association, Inc.