Abstract 17608: Ethnic and Sex Differences in Ambulance Activation Among Hospitalized Patients With St-elevation Myocardial Infarction
Introduction: Emergency medical service (EMS) activation has become an integral component in managing ST-elevation myocardial infarction (STEMI) patients. Within an integrated STEMI system of care, emergency transfer by EMS reduces ischemic time and treatment delays. Yet, EMS activation remains under-utilized.
Hypothesis: We examined whether EMS activation varies by ethnicity or sex among a large provincial cohort of STEMI patients.
Methods: Patients > 18 years of age hospitalized with STEMI in Alberta, Canada between April 1 2007 and March 31 2013 were included. Validated naming algorithms were used to categorize patients according to ethnicity (Caucasian, Chinese, South Asian, or Other Asian [Filipino, Japanese, Vietnamese, Korean]). Unadjusted rates of presentation by EMS (ground ambulance) versus self-presentation were compared across ethnic groups and by sex. Multivariable logistic regression was used to determine whether ethnicity and sex were independently associated with EMS presentation.
Results: Of the 11, 972 STEMI patients, 50.2% presented to hospital via ambulance. Compared with self-presenters, patients presenting with EMS were older (66.7 years vs. 61.8 years p<0.001), more commonly female (33.1% vs. 23.9%, p<0.001) and had prior cardiovascular conditions (myocardial infarction: 7.1% vs. 6.2%, p=0.055; heart failure: 14.5% vs. 8.0%, p<0.001; atrial fibrillation: 10.1% vs. 6.4%, p<0.001). Differences in ethnic EMS activation were noted (Caucasian 50.0% [5771/11541] vs. Chinese 60.0% [88/147] vs. South Asian 57.0% [110/192] vs. other Asian 49.5% [45/91], p=0.026). After adjustment, both ethnicity and gender remained independent predictors of EMS activation (Figure).
Conclusion: In a provincial cohort of patients with STEMI, activation of EMS appears suboptimal and differs by ethnicity and sex. Further efforts are required to address these disparities in order to enhance public awareness of ambulance activation for chest pain.
Author Disclosures: A. Gupta: None. P. Kaul: None. W. Alemayehu: None. R. Welsh: None. K. Bainey: None.
- © 2016 by American Heart Association, Inc.