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Utilization of EMS Transport Among Patients with STEMI Findings from the National Cardiovascular Data ACTION Registry–Get With The Guidelines PowerPoint PPT Presentation


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Utilization of EMS Transport Among Patients with STEMI Findings from the National Cardiovascular Data ACTION Registry–Get With The Guidelines. Robin Mathews, Eric Peterson, Shuang Li, Matthew Roe, Stephen Wiviott, Jorge Saucedo, Elliott Antman, Tracy Wang. STEMI: Time is Muscle.

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Utilization of EMS Transport Among Patients with STEMI Findings from the National Cardiovascular Data ACTION Registry–Get With The Guidelines

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Utilization of EMS Transport Among Patients with STEMI Findings from the National Cardiovascular Data ACTION Registry–Get With The Guidelines

Robin Mathews, Eric Peterson, Shuang Li, Matthew Roe,

Stephen Wiviott, Jorge Saucedo, Elliott Antman, Tracy Wang


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STEMI: Time is Muscle


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ACC/AHA Guidelines for STEMI Care

  • Early evaluation (e.g., pre-hospital ECG)

  • Pre-hospital stabilization

  • Expedited triage by receiving hospital

NRMI data (1990s) showed only 50% EMS use

Antman, EM, 2004 JACC (45); 671-719

Canto, JG. 2002 Circulation (106): 3018-3023


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Gaps in the Data

  • What are contemporary patterns of EMS vs. self transport use among STEMI patients?

  • What are the barriers to EMS utilization?

  • Does EMS use improve timeliness of subsequent treatment?


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ACTION Registry®-GWTG™ STEMI population

Jan 01, 2007-SEP 30, 2009

Missing mode of transport Transfer- in patients

Missing home zip code information

Study Population

18,069 patients, 296 hospitals

Self Transport

6,988 patients

38.7 %

EMS Transport

11,081 patients

61.3 %


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Sociodemographic Factors Associated with EMS-Transport

*Other variables in this model: dyslipidemia, diabetes mellitus, prior HF, HTN, atrial fibrillation/atrial flutter, prior MI, prior stroke, BMI, heart rate, dialysis, educational level, income level, race, time of presentation, rural vs. urban location


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Clinical Factors Associated with EMS-Transport


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600

500

400

300

200

100

0

< 4 miles

4-10 miles

>10 miles

P-value

<0.0001

<0.0001

<0.0001

EMS Transport Reduces Symptom Onset to Hospital Arrival Time Regardless of Distance Traveled

EMS

Self

Time (min)


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Treatment Differences Between

EMS- and Self-Transport

13 min

3 min

31 min

P<0.001 for all

Adjusted OR (95%CI)

Sx onset to arrival ≤ 120 min Time to ECG ≤ 10 min D2B ≤ 90 min

0.55 (0.50-0.60) 0.52 (0.46-0.59) 0.43 (0.37-0.50)


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Limitations

  • Income and educational levels derived from home zip code and census data.

  • Distance traveled derived from home to hospital zip code and only approximates the travel distance for an individual patient

  • ACTION-GWTG did not capture symptom severity

  • .


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Conclusions

  • EMS continues to be underutilized among STEMI patients in contemporary practice

  • Estimates of socioeconomic factors, such as household income and insurance status, did not predict EMS utilization

  • Patients who use EMS have significantly shorter delays to presentation and treatment, even among patients who live close to the hospital


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Implications

  • EMS use, by reducing the delay from symptom onset to hospital arrival alone, is associated with a >30 minute reduction in ischemic time

  • More work is needed to promote EMS use as emphasized by Mission Lifeline’s ‘chain of survival’

  • Community education efforts should be tailored to groups that underutilize EMS and integrated with system-wide strategies to promote the timely use of reperfusion


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