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Factors Associated with Emergency Medical Service Use for Acute Coronary Syndrome Patients in Victoria
Abstracts
100 This abstract has been withdrawn 101 Evolving Access to Coronary Revascularisation for STEACS in Regional Australia J. Yeoh 1,∗ , L. Cunningham 1 , C. Hengel 1 , A. Sharma 1 , E. Oqueli 1,3 , R. MacFadyen 1,2 1 Ballarat
Health Services, Australia University, Australia 3 The University of Melbourne, Australia 2 Deakin
Background: Access to angiography/coronary reperfusion for ST elevation acute coronary syndrome (STEACS) is a global standard of care increasingly available in regional Australia. We report service evolution in a regional centre with 24hr/5 day a week percutaneous coronary intervention (PCI) access without onsite cardiac surgery. Method: Retrospective review of STEACS treated by thrombolysis; emergent PCI and/or tertiary referral. Results: 231 STEACS cases (72.7% male; average age 64.2 years) over 3 years comprised, in addition to coronary occlusions, 2 non-obstructive coronary artery disease, 2 Takotsubo Cardiomyopathy, 1 Hypertrophic Cardiomyopathy, 1 coronary spasm and 2 cases of coronary embolism. 12 cases followed out of hospital cardiac arrest. Of 164 onsite presentations, 104 were out of hours (weekends/1700 hrs to 0800 hrs weekdays). 67 cases transferred from peripheral hospitals, of which, 24 received thrombolysis prior to transfer. 14 cases then progressed to urgent angiography (13 emergent PCI/1 emergent coronary bypass). Percentage offsite thrombolysis dropped during the audit period (2013, 15.3%; 2014, 7.1%; 2015, 7.9%). Additionally 15 cases were managed by onsite thrombolysis. 13 cases (5.6%) were managed by transfer for bypass surgery following diagnostic angiography. There were 18 (7.8%) in hospital deaths in the total cohort (78.8% direct coronary; 22.2% non-coronary) with 2 deaths following thrombolysis. 13 cases (5.6%) were managed conservatively without angiography/thrombolysis (citing advanced age and/or excess comorbidity). Conclusion: Regional centres can safely initiate and sustain PCI services for STEACS with gradual uptake. Despite the increasing availability of immediate access PCI, systemic thrombolysis continues to be used for coronary reperfusion in regional Australia. http://dx.doi.org/10.1016/j.hlc.2016.06.102
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102 Factors Associated with Emergency Medical Service Use for Acute Coronary Syndrome Patients in Victoria S. Cartledge 1,2,∗ , J. Bray 1,2,3 , D. Stub 1,2 , P. Ngu 2 , L. Straney 1 , M. Stewart 4 , W. Keech 4 , H. Patsamanis 4 , J. Shaw 2 , J. Finn 1,3 1 Monash
University, Melbourne, Australia Hosptial, Melbourne, Australia 3 Curtin University, Perth, Australia 4 Heart Foundation, Melbourne, Australia 2 Alfred
Background: Only half of acute coronary syndrome (ACS) patients use emergency medical services (EMS) to present to hospital. The recent National Heart Foundation’s (NHF) Warning Signs campaign addressed some of the known barriers to calling an ambulance. Aim: To explore the impact of the NHF campaign on EMS use in ACS patients. Methods: Interviews were conducted with 199 consecutive ACS patients admitted to a Melbourne hospital between July 2013 and April 2014. Logistic regression was used to examine factors associated with ambulance use. Results: Only 53% of patients presented by ambulance. Use was highest in patients admitted with STEMI (69%), compared to non-STEMI (51%) and unstable angina (47%). EMS use was not associated with seeing the campaign (52% versus 57%, p = 0.50), or in those who stated the campaign influenced their behaviour (52% versus 57%, p = 0.78). Almost half (43%) of those who did not use an ambulance thought it would be faster to use own transport. Factors associated with EMS use were: age >65 years, current smoking, STEMI, sudden onset of symptoms and not having a perceived sense of control of symptoms. Conclusions: Our study suggests the NHF campaign has not changed EMS use for ACS, although use was high in STEMI patients. The dangers of driving to hospital and the clinical role that EMS play needs to be emphasised and targeted to low awareness groups. Further research is needed to identify what campaign messages could increase EMS use in ACS patients. http://dx.doi.org/10.1016/j.hlc.2016.06.103
100 This abstract has been withdrawn 101 Evolving Access to Coronary Revascularisation for STEACS in Regional Australia J. Yeoh 1,∗ , L. Cunningham 1 , C. Hengel 1 , A. Sharma 1 , E. Oqueli 1,3 , R. MacFadyen 1,2 1 Ballarat
Health Services, Australia University, Australia 3 The University of Melbourne, Australia 2 Deakin
Background: Access to angiography/coronary reperfusion for ST elevation acute coronary syndrome (STEACS) is a global standard of care increasingly available in regional Australia. We report service evolution in a regional centre with 24hr/5 day a week percutaneous coronary intervention (PCI) access without onsite cardiac surgery. Method: Retrospective review of STEACS treated by thrombolysis; emergent PCI and/or tertiary referral. Results: 231 STEACS cases (72.7% male; average age 64.2 years) over 3 years comprised, in addition to coronary occlusions, 2 non-obstructive coronary artery disease, 2 Takotsubo Cardiomyopathy, 1 Hypertrophic Cardiomyopathy, 1 coronary spasm and 2 cases of coronary embolism. 12 cases followed out of hospital cardiac arrest. Of 164 onsite presentations, 104 were out of hours (weekends/1700 hrs to 0800 hrs weekdays). 67 cases transferred from peripheral hospitals, of which, 24 received thrombolysis prior to transfer. 14 cases then progressed to urgent angiography (13 emergent PCI/1 emergent coronary bypass). Percentage offsite thrombolysis dropped during the audit period (2013, 15.3%; 2014, 7.1%; 2015, 7.9%). Additionally 15 cases were managed by onsite thrombolysis. 13 cases (5.6%) were managed by transfer for bypass surgery following diagnostic angiography. There were 18 (7.8%) in hospital deaths in the total cohort (78.8% direct coronary; 22.2% non-coronary) with 2 deaths following thrombolysis. 13 cases (5.6%) were managed conservatively without angiography/thrombolysis (citing advanced age and/or excess comorbidity). Conclusion: Regional centres can safely initiate and sustain PCI services for STEACS with gradual uptake. Despite the increasing availability of immediate access PCI, systemic thrombolysis continues to be used for coronary reperfusion in regional Australia. http://dx.doi.org/10.1016/j.hlc.2016.06.102
S45
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102 Factors Associated with Emergency Medical Service Use for Acute Coronary Syndrome Patients in Victoria S. Cartledge 1,2,∗ , J. Bray 1,2,3 , D. Stub 1,2 , P. Ngu 2 , L. Straney 1 , M. Stewart 4 , W. Keech 4 , H. Patsamanis 4 , J. Shaw 2 , J. Finn 1,3 1 Monash
University, Melbourne, Australia Hosptial, Melbourne, Australia 3 Curtin University, Perth, Australia 4 Heart Foundation, Melbourne, Australia 2 Alfred
Background: Only half of acute coronary syndrome (ACS) patients use emergency medical services (EMS) to present to hospital. The recent National Heart Foundation’s (NHF) Warning Signs campaign addressed some of the known barriers to calling an ambulance. Aim: To explore the impact of the NHF campaign on EMS use in ACS patients. Methods: Interviews were conducted with 199 consecutive ACS patients admitted to a Melbourne hospital between July 2013 and April 2014. Logistic regression was used to examine factors associated with ambulance use. Results: Only 53% of patients presented by ambulance. Use was highest in patients admitted with STEMI (69%), compared to non-STEMI (51%) and unstable angina (47%). EMS use was not associated with seeing the campaign (52% versus 57%, p = 0.50), or in those who stated the campaign influenced their behaviour (52% versus 57%, p = 0.78). Almost half (43%) of those who did not use an ambulance thought it would be faster to use own transport. Factors associated with EMS use were: age >65 years, current smoking, STEMI, sudden onset of symptoms and not having a perceived sense of control of symptoms. Conclusions: Our study suggests the NHF campaign has not changed EMS use for ACS, although use was high in STEMI patients. The dangers of driving to hospital and the clinical role that EMS play needs to be emphasised and targeted to low awareness groups. Further research is needed to identify what campaign messages could increase EMS use in ACS patients. http://dx.doi.org/10.1016/j.hlc.2016.06.103