First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study
Ingela Thylén1, Maria Ericsson2, Karin Hellström Ängerud3
1Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Insights
Patients with ST-elevation myocardial infarction (STEMI) using Swedish Healthcare Direct (SHD) as first medical contact instead of Emergency Medical Services (EMS) experience longer diagnosis times. This delay may negatively impact patient prognosis.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- ST-elevation myocardial infarction (STEMI) is a critical medical emergency.
- Timely diagnosis and treatment are crucial for STEMI patient outcomes.
- Understanding patient first medical contact (FMC) pathways is essential for optimizing emergency care.
Purpose of the Study:
- To determine the extent to which patients with STEMI use Swedish Healthcare Direct (SHD) versus Emergency Medical Services (EMS) as their FMC.
- To identify factors influencing the choice between SHD and EMS for STEMI patients.
- To analyze the impact of FMC choice on the time from symptom onset to diagnosis in STEMI patients.
Main Methods:
- Multicenter, cross-sectional study conducted in Sweden.
- Inclusion of consecutive STEMI patients admitted within 24 hours.
- Data collection on patient demographics, FMC, reasons for FMC choice, and time to diagnosis.
Main Results:
- While 83% arrived by ambulance, only 51% used EMS as FMC; 21% used SHD, 14% contacted primary care, and 14% went directly to the emergency room.
- Reasons for not calling EMS included perceived faster personal transport (40%) and underestimation of symptom severity (30%).
- Contacting SHD as FMC was associated with longer symptom onset to diagnosis times (1:59 hours) compared to EMS (1:21 hours).
Conclusions:
- Utilizing alternatives to EMS, such as SHD, as the primary contact for STEMI significantly prolongs diagnosis time.
- Delayed diagnosis due to non-EMS contact may adversely affect patient prognosis.
- However, accessible services like SHD may encourage some patients to seek care who might otherwise delay seeking medical attention.
Objective:
It is unknown into what extent patients with ST-elevation myocardial infarction (STEMI) utilise a joint service number (Swedish Healthcare Direct, SHD) as first medical contact (FMC) instead of Emergency Medical Services (EMS) and how this impact time to diagnosis. We aimed to (1) describe patients' FMC; (2) find explanatory factors influencing their FMC (ie, EMS and SHD) and (3) explore the time interval from symptom onset to diagnosis.
Setting:
Multicentred study, Sweden.
Methods:
Cross-sectional, enrolling patients with consecutive STEMI admitted within 24 h from admission.
Results:
We included 109 women and 336 men (mean age 66±11 years). Although 83% arrived by ambulance to the hospital, just half of the patients (51%) called EMS as their FMC. Other utilised SHD (21%), contacted their primary healthcare centre (14%), or went directly to the emergency room (14%). Reasons for not contacting EMS were predominantly; (1) my transport mode was faster (40%), (2) did not consider myself sick enough (30%), and (3) it was easier to be driven or taking a taxi (25%). Predictors associated with contacting SHD as FMC were female gender (OR 1.92), higher education (OR 2.40), history of diabetes (OR 2.10), pain in throat/neck (OR 2.24) and pain intensity (OR 0.85). Predictors associated with contacting EMS as FMC were history of MI (OR 2.18), atrial fibrillation (OR 3.81), abdominal pain (OR 0.35) and believing the symptoms originating from the heart (OR 1.60). Symptom onset to diagnosis time was significantly longer when turning to the SHD instead of the EMS as FMC (1:59 vs 1:21 h, p<0.001).
Conclusions:
Using other forms of contacts than EMS, significantly prolong delay times, and could adversely affect patient prognosis. Nevertheless, having the opportunity to call the SHD might also, in some instances, lower the threshold for taking contact with the healthcare system, and thus lowers the number that would otherwise have delayed even longer.
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