Affiliation:
1. Department of Paramedicine, Monash University, Australia
2. Department of Epidemiology and Preventive Medicine, Monash University, Australia
3. Ambulance Victoria, Australia
4. Alfred Hospital, Australia
5. Baker IDI Heart and Diabetes Institute, Australia
Abstract
Abstract
Objective
The purpose of this study was to identify factors associated with time delay to emergency medical services for patients with suspected ST-elevation myocardial infarction.
Methods
This observational study involved 1994 suspected ST-elevation myocardial infarction patients presenting to the emergency medical services in Melbourne, Australia, between October 2011–January 2014. Factors associated with delays to emergency medical services call of >1 h and emergency medical services self-referral were analyzed using multivariable logistic regression.
Results
The time of symptom onset was reported for 1819 patients (91.2%), the median symptom onset-to-call time was 52 min (interquartile range = 17–176). Of all emergency medical services calls, 17% were referred by healthcare professionals. Compared to self-referred patients, patients who presented to a general practitioner or hospital had higher odds of delay >1 h to emergency medical services activation (adjusted odds ratio 7.76; 95% confidence interval 5.10–11.83; and 8.02; 3.65–17.64, respectively). The other factors associated with emergency medical services call delays of >1 h were living alone, non-English speaking background, a history of substance abuse, less severe symptoms, symptom onset at home and at rest, and self-treatment. Emergency medical services self-referred patients were more likely to be older than 75 years, have a history of ischemic heart disease or revascularization, more severe symptoms, and symptom onset at home, with activity, during the weekends and out-of-hours.
Conclusion
Almost one-fifth of emergency medical services calls for suspected ST-elevation myocardial infarction were healthcare referrals, and this was associated with increased delays. A wide range of factors could influence a patient’s decision to directly and rapidly seek emergency medical services. More efforts are needed to educate at-risk populations about early self-referral to the emergency medical services.
Funder
National Health and Medical Research Council (NHMRC) Early Career Fellowship
National Heart Foundation Fellowship and Viertel Foundation award
National Heart Foundation Fellowship
Publisher
Oxford University Press (OUP)
Subject
Advanced and Specialized Nursing,Medical–Surgical Nursing,Cardiology and Cardiovascular Medicine
Cited by
3 articles.
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