on November 25, 2002
Circulation. 2002
Published online before print November 25, 2002, doi: 10.1161/01.CIR.0000041246.20352.03
Published online before print November 25, 2002, doi: 10.1161/01.CIR.0000041246.20352.03
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Submitted on August 9, 2002
From the Chest Pain Center and Division of Cardiovascular Diseases (J.G.C., W.J.R.), Center for Outcomes and Effectiveness Research and Education (J.G.C., C.I.K.), University of Alabama at Birmingham; Wayne State University School of Medicine, Detroit, Mich (R.J.Z.); Medical College of Virginia, Richmond, Va (J.P.O.); University of Colorado, Denver, Colo (D.M.); the University of California at San Francisco, San Francisco, Calif (M.G.S., H.V.B.); University of Washington Cardiology Outcomes Research Center, Seattle, Wash (P.D.F.); University of Vermont, Portland, Me (C.G.L.); and Genentech, Inc, South San Francisco, Calif (K.A.L., H.V.B.).
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.
Revised on September 23, 2002
Accepted on September 23, 2002
Use of Emergency Medical Services in Acute Myocardial Infarction and Subsequent Quality of Care. Observations From the National Registry of Myocardial Infarction 2
John G. Canto MD, MSPH*,
Key words: myocardial infarction • chest pain • ambulances • emergency medical services
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