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UNDERSTANDING THE PATTERNS AND EFFECTS OF EMERGENCY MEDICAL SERVICE UTILIZATION IN ACUTE CORONARY SYNDROME PATIENTS
E382 JACC March 27, 2012 Volume 59, Issue 13
Acute Coronary Syndromes UNDERSTANDING THE PATTERNS AND EFFECTS OF EMERGENCY MEDICAL SERVICE UTILIZATION IN ACUTE CORONARY SYNDROME PATIENTS ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Acute Coronary Syndromes: Clinical I Abstract Category: 5. Acute Coronary Syndromes: Clinical Presentation Number: 1163-8 Authors: Suzanne Baron, Arvind Agnihotri, Andrew Eisenhauer, David Roberts, James McCabe, Hui Zheng, john nagurney, Everett Lyn, Robert Yeh, Massachusetts General Hospital, Boston, MA, USA, Brigham and Women’s Hospital, Boston, MA, USA Background: In patients with acute coronary syndromes (ACS), the use of emergency medical services (EMS) may allow for earlier diagnosis, stabilization and triage to a percutaneous coronary intervention (PCI) facility. Thus, use of EMS may lead to improvement in outcomes, particularly in those patients at highest risk for adverse events. Few studies have described patterns of EMS use among ACS patients, including whether patients at higher risk for events preferentially use EMS, and the association of EMS use with outcomes. Methods: We identified all patients undergoing PCI for ACS between 1/2004 and 12/2007 at 3 centers (Brigham and Women’s Hospital, Massachusetts General Hospital, North Shore Medical Center) and divided them into 2 groups based on EMS- or self-transport to the hospital. We compared baseline characteristics, including predicted in-hospital mortality based on the ACC-NCDR prediction score, and used multivariable logistic regression to identify factors that predicted EMS use. Long-term mortality in all ACS patients as well as door-to-balloon (DTB) times for STelevation myocardial infarction (STEMI) patients were compared using the log rank test and Cox proportional hazards models. Results: Of 2429 patients identified, 45.9% utilized self-transport versus 54.1% who used EMS. Older patients, females, and patients with STEMI, chronic lung disease or severe heart failure were more likely to use EMS. EMS patients had 2-fold higher predicted in-hospital mortality rates (1.2% ± 0.2% vs. 0.6% ± 0.1%). In crude analyses, EMS use was associated with worse 3-year mortality (HR 2.61; 95% CI 1.90-3.57); however, this association was not present after adjustment for NCDR risk. In the STEMI subgroup, EMS use was associated with shorter median DTB (77 min [58, 108] vs. 95 min [75, 128], p < 0.0001). Conclusions: Nearly half of ACS patients rely on self transport to the hospital. However, those with worse clinical status are more likely to use EMS, thereby representing appropriate self-selection for EMS use by high risk patients. For STEMI patients, EMS use is associated with shorter DTB. Strategies that increase EMS use in high-risk ACS patients may improve timely delivery of therapies and outcomes.
Acute Coronary Syndromes UNDERSTANDING THE PATTERNS AND EFFECTS OF EMERGENCY MEDICAL SERVICE UTILIZATION IN ACUTE CORONARY SYNDROME PATIENTS ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Acute Coronary Syndromes: Clinical I Abstract Category: 5. Acute Coronary Syndromes: Clinical Presentation Number: 1163-8 Authors: Suzanne Baron, Arvind Agnihotri, Andrew Eisenhauer, David Roberts, James McCabe, Hui Zheng, john nagurney, Everett Lyn, Robert Yeh, Massachusetts General Hospital, Boston, MA, USA, Brigham and Women’s Hospital, Boston, MA, USA Background: In patients with acute coronary syndromes (ACS), the use of emergency medical services (EMS) may allow for earlier diagnosis, stabilization and triage to a percutaneous coronary intervention (PCI) facility. Thus, use of EMS may lead to improvement in outcomes, particularly in those patients at highest risk for adverse events. Few studies have described patterns of EMS use among ACS patients, including whether patients at higher risk for events preferentially use EMS, and the association of EMS use with outcomes. Methods: We identified all patients undergoing PCI for ACS between 1/2004 and 12/2007 at 3 centers (Brigham and Women’s Hospital, Massachusetts General Hospital, North Shore Medical Center) and divided them into 2 groups based on EMS- or self-transport to the hospital. We compared baseline characteristics, including predicted in-hospital mortality based on the ACC-NCDR prediction score, and used multivariable logistic regression to identify factors that predicted EMS use. Long-term mortality in all ACS patients as well as door-to-balloon (DTB) times for STelevation myocardial infarction (STEMI) patients were compared using the log rank test and Cox proportional hazards models. Results: Of 2429 patients identified, 45.9% utilized self-transport versus 54.1% who used EMS. Older patients, females, and patients with STEMI, chronic lung disease or severe heart failure were more likely to use EMS. EMS patients had 2-fold higher predicted in-hospital mortality rates (1.2% ± 0.2% vs. 0.6% ± 0.1%). In crude analyses, EMS use was associated with worse 3-year mortality (HR 2.61; 95% CI 1.90-3.57); however, this association was not present after adjustment for NCDR risk. In the STEMI subgroup, EMS use was associated with shorter median DTB (77 min [58, 108] vs. 95 min [75, 128], p < 0.0001). Conclusions: Nearly half of ACS patients rely on self transport to the hospital. However, those with worse clinical status are more likely to use EMS, thereby representing appropriate self-selection for EMS use by high risk patients. For STEMI patients, EMS use is associated with shorter DTB. Strategies that increase EMS use in high-risk ACS patients may improve timely delivery of therapies and outcomes.