Use of Emergency Medical services in acute Myocardial Infarction and subsequent quality of care: Observations from the National Registry of Myocardial Infarction 2

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 wi...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2002-12, Vol.106 (24), p.3018-3023
Main Authors: CANTO, John G, ZALENSKI, Robert J, BARRON, Hal V, ORNATO, Joseph P, ROGERS, William J, KIEFE, Catarina I, MAGID, David, SHLIPAK, Michael G, FREDERICK, Paul D, LAMBREW, Costas G, LITTRELL, Katherine A
Format: Article
Language:English
Subjects:
Aged
Ambulances - statistics & numerical data
Biological and medical sciences
Cardiology. Vascular system
Coronary heart disease
Cross-Sectional Studies
Demography
Emergency Medical Services - standards
Emergency Medical Services - statistics & numerical data
Female
Heart
Hospital Mortality
Humans
Male
Medical sciences
Middle Aged
Myocardial Infarction - diagnosis
Myocardial Infarction - therapy
Myocardial Reperfusion - statistics & numerical data
Odds Ratio
Outcome Assessment (Health Care) - statistics & numerical data
Quality of Health Care - statistics & numerical data
Registries - statistics & numerical data
Time Factors
Transportation of Patients - statistics & numerical data
United States
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Summary: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. 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
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.0000041246.20352.03