Bypassing Emergency Service: Decoding the Drivers of Self-Referral During Acute Myocardial Infarction on Rural Areas...

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Timely management of acute myocardial infarction (AMI) is critical for patient outcomes.
• Self-referral, defined as patients arriving at the hospital independently or via private transport, can lead to treatment delays.
• Understanding factors influencing self-referral is essential for improving AMI care pathways.

Purpose of the Study:

• To identify factors associated with self-referral in patients with AMI in Saxony-Anhalt, Germany.
• To assess the impact of self-referral on reaching a hospital equipped for percutaneous coronary intervention (PCI).
• To investigate potential gender disparities in transport to PCI-capable facilities.

Main Methods:

• Utilized data from the Regional Myocardial Infarction Registry of Saxony-Anhalt (RHESA).
• Included 4044 patients with confirmed AMI, analyzing urban vs. rural populations and demographic factors.
• Employed multivariable logistic regression to determine factors associated with self-referral and PCI-capable hospital arrival.

Main Results:

• Rural residents showed a significantly higher likelihood of self-referral (aOR 2.43).
• Self-referral likelihood decreased with age; metabolic factors and sex were not significantly associated.
• Self-referral did not impede arrival at PCI-capable hospitals (aOR 1.12), and women did not face a disadvantage in self-referred cases.
• However, women experienced a disadvantage in medically attended transports to PCI-capable hospitals (OR 1.33).

Conclusions:

• Rural residence is a key factor associated with AMI self-referral.
• Public awareness campaigns regarding appropriate emergency transport for AMI are warranted.
• Training for medical personnel is crucial to mitigate gender bias in AMI patient transport to PCI-capable facilities.