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Article
Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction 2
Quantitative Health Sciences Publications and Presentations
  • John G. Canto, University of Alabama
  • Robert J. Zalenski
  • Joseph P. Ornato
  • William J. Rogers, University of Alabama
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • David Magid, University of Colorado
  • Michael G. Shlipak, University of California
  • Paul D. Frederick
  • Costas G. Lambrew
  • Katherine A. Littrell
  • Hal V. Barron, University of California
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
12-11-2002
Document Type
Article
Subjects
Aged; Ambulances; Cross-Sectional Studies; Demography; Emergency Medical Services; Female; Hospital Mortality; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Odds Ratio; Outcome Assessment (Health Care); Quality of Health Care; Registries; Time Factors; Transportation of Patients; United States
Abstract

BACKGROUND: National practice guidelines strongly recommend activation of the 9-1-1 Emergency Medical Systems (EMS) by patients with symptoms consistent with an acute myocardial infarction (MI). We examined use of the EMS in the United States and ascertained the factors that may influence its use by patients with acute MI.

METHODS AND RESULTS: From June 1994 to March 1998, the National Registry of Myocardial Infarction 2 enrolled 772 586 patients hospitalized with MI. We excluded those who transferred in, arrived at the hospital >6 hours from symptom onset, or who were in cardiogenic shock. We compared baseline characteristics and initial management for patients who arrived by ambulance versus self-transport. EMS was used in 53.4% of patients with MI, a proportion that did not vary significantly over the 4-year study period. Nonusers of the EMS were on average younger, male, and at relatively lower risk on presentation. In addition, payer status was significantly associated with EMS use. Use of EMS was independently associated with slightly wider use of acute reperfusion therapies and faster time intervals from door to fibrinolytic therapy (12.1 minutes faster, P<0.001) or to urgent PTCA (31.2 minutes faster, P<0.001).

CONCLUSIONS: Only half of patients with MI were transported to the hospital by ambulance, and these patients had greater and significantly faster receipt of initial reperfusion therapies. Wider use of EMS by patients with suspected MI may offer considerable opportunity for improvement in public health.

Rights and Permissions
Citation: Circulation. 2002 Dec 10;106(24):3018-23.
PubMed ID
12473545
Related Resources
Link to Article in PubMed
Citation Information
John G. Canto, Robert J. Zalenski, Joseph P. Ornato, William J. Rogers, et al.. "Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction 2" Vol. 106 Iss. 24 (2002) ISSN: 0009-7322 (Linking)
Available at: http://works.bepress.com/catarina_kiefe/35/