Mobile coronary care and mortality from ischaemic heart disease in a predominantly rural community
Insights
A mobile coronary care unit improved patient outcomes for myocardial infarction. Early intervention by the mobile unit, especially for younger patients within three hours of symptom onset, significantly reduced mortality rates.
Area of Science:
- Cardiology
- Emergency Medical Services
Background:
- Mobile coronary care units provide critical pre-hospital care for acute myocardial infarction (MI).
- Timely medical intervention is crucial for improving survival rates in patients with ischemic heart disease.
Purpose of the Study:
- To evaluate the effectiveness of a mobile coronary care unit (MCCU) in managing patients with myocardial infarction in the community.
- To compare the outcomes of patients treated by the MCCU versus those admitted through conventional hospital routes.
Main Methods:
- Prospective study of patients attended by the MCCU and those admitted via ambulance or other hospital departments.
- Data collection included patient demographics, time to treatment, interventions performed (e.g., defibrillation), and mortality rates.
Main Results:
- The MCCU attended 155 patients, with 74 diagnosed with MI. Patients seen by the MCCU received care significantly earlier than those admitted via ordinary ambulance.
- Overall MI mortality was 19.8%, higher in patients aged 70 years or older.
- A subgroup of patients under 70 treated by the MCCU within three hours of symptom onset had the lowest mortality (6.7%).
- Nine MCCU patients required defibrillation (four pre-hospital), with eight surviving to discharge.
Conclusions:
- The mobile coronary care unit demonstrated a positive impact on patient care and survival for myocardial infarction.
- Early intervention by the MCCU, particularly within three hours for younger patients, is associated with significantly lower mortality.
- The study suggests a potentially high mortality rate among ischemic heart disease patients not admitted to the hospital.
Abstract:
The mobile coronary care unit based at Coleraine Hospital was called to 155 patients in the community during a six-monthly period, 74 of whom had sustained a myocardial infarction. Over the same period, 25 of 49 patients admitted via the ordinary ambulance with suspected ischaemic heart disease had sustained a myocardial infarction and received medical care significantly later than those seen by the mobile unit. A further 12 patients out of 39 with suspected ischaemic heart disease admitted by other means (the accident and emergency department or other hospital units) brought the total number of patients admitted to hospital with myocardial infarction during the study period to 111.Overall mortality from myocardial infarction was 19.8% and was significantly higher in those >/= 70 years of age. Nine patients with myocardial infarction seen by the mobile coronary care unit required early defibrillation (four outside hospital) and eight of these survived to be discharged. No patients admitted by other means required emergency defibrillation. Although no significant difference in mortality was demonstrated between those seen before or after three hours from the onset of symptoms or between patients admitted by the mobile unit or by the ordinary ambulance, a subgroup of patients below 70 years of age and seen by the mobile unit less than three hours after the onset of symptoms had the lowest mortality of 6.7%. Estimated overall mortality from ischaemic heart disease in this community over the study period was in excess of those deaths accounted for in this survey, implying a high mortality in those not admitted to hospital.
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