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Ambulance use, distance and outcomes in patients with suspected cardiovascular disease: a registry-based geographic
Nariman Sepehrvand1,2, Wendimagegn Alemayehu1, Padma Kaul1,2
1Canadian VIGOUR Centre, University of Alberta, Canada.
Insights
Most patients with acute coronary syndrome symptoms don't use emergency medical services (EMS). EMS use was linked to higher risks of adverse events, despite longer travel distances not predicting outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Most patients with acute coronary syndrome (ACS) symptoms do not utilize emergency medical services (EMS) to reach the emergency department (ED).
- Understanding factors influencing EMS use and its impact on patient outcomes is crucial for improving emergency care.
Purpose of the Study:
- To investigate factors associated with emergency medical services utilization among patients with symptoms suggestive of acute coronary syndrome.
- To examine the subsequent patient outcomes related to emergency medical services use.
Main Methods:
- Retrospective analysis of administrative data from Edmonton and Calgary EDs (2007-2013).
- Inclusion of patients with main ED diagnoses of acute coronary syndrome, stable angina, or chest pain.
- Estimation of travel distance using geographic information systems and assessment of 7-day and 30-day all-cause clinical events.
Main Results:
- 30.5% of 50,881 patients used EMS.
- Older age, female sex, ACS diagnosis, comorbidities, and lower income were associated with higher EMS use.
- Longer travel distance correlated with increased EMS use but was not a predictor of clinical events. EMS use was linked to higher 7-day and 30-day event risks after adjustment.
Conclusions:
- Demographic and clinical factors, along with geographical variations, influence EMS utilization.
- While longer travel distances correlate with EMS use, they do not independently predict patient outcomes.
- Findings have implications for designing EMS systems, triage protocols, and early diagnostic/treatment strategies.
Background:
Despite guideline recommendations, the majority of patients with symptoms suggestive of acute coronary syndrome do not use emergency medical services to reach the emergency department (ED). The aim of this study was to investigate the factors associated with EMS utilisation and subsequent patient outcomes.
Methods:
Using administrative data, all patients who presented to an ED in the metropolitan areas of Edmonton and Calgary in the years of 2007-2013 with main ED diagnosis of acute coronary syndrome, stable angina or chest pain were included. The travel distance was estimated using the geographic information system method to approximate the distance between the ED and patient home. The clinical endpoints were the 7-day and 30-day all-cause events (death, re-hospitalisation and repeat ED visit).
Results:
Of 50,881 patients, 30.5% presented by emergency medical services. Patients with older age, female sex, ED diagnosis of acute coronary syndrome, more comorbidities and lower household income were more likely to use emergency medical services to reach the hospital. Longer travel distance was associated with higher emergency medical services use (odds ratio 1.09, 95% confidence interval 1.09-1.10), but it was not a predictor of clinical events. After adjustment for covariates and inverse propensity score weighting, emergency medical services use was associated with a higher risk of 7-day and 30-day clinical events.
Conclusion:
Several demographic and clinical features were associated with higher emergency medical services use including geographical variation. Although longer travel distance was shown to be linked to higher emergency medical services use, it was not an independent predictor of patient outcome. This has implications for the design of emergency medical services systems, triage and early diagnosis and treatment options.
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