Emergency Medical Service Use for Acute Coronary Syndrome in Culturally and Linguistically Diverse Immigrant...

In acute coronary syndrome (ACS), emergency medical service (EMS) use reduces pre-hospital delay and increases the chances of survival. However, evidence regarding EMS use in culturally and linguistically diverse (CALD) patients is conflicting. This study aimed to i) examine whether EMS use in patients with ACS varies between CALD and non-CALD populations and ii) identify characteristics associated with EMS and non-EMS use in CALD patients.

This is a retrospective analysis of ACS cases presented to emergency departments of public hospitals in Victoria, Australia between January 2016 and June 2021, as recorded in the Victorian Emergency Minimum Dataset maintained by the Victorian Department of Health. Country of birth, preferred language, and the need for an interpreter defined CALD status. Logistic regression was used to describe the characteristics associated with EMS and non-EMS use.

Of the 51,101 eligible ACS cases, 15,580 (30.5%) were from the CALD group. EMS use was lower in CALD than in non-CALD groups (61.9% vs 65.3%; p<0.001; adjusted odds ratio [aOR] 0.78; 95% confidence Interval [CI] 0.75-0.81). In CALD patients, the odds of EMS use increased with advancing age, living alone (aOR 1.45; 95% CI 1.24-1.70), self-referral (aOR 4.53; 95% CI 3.97-5.17), hospital presentation in the year 2020 (aOR 1.16; 95% CI 1.03-1.31) or 2021 (aOR 1.20; 95% CI 1.30-1.39), and being diagnosed with acute myocardial infarction (aOR 1.36; 95% CI 1.26-1.39). Reduced odds of EMS use were associated with being born in Southeast Asia (aOR 0.71; 95% CI 0.57-0.89), Northeast Asia (aOR 0.57; 95% CI 0.42-0.77), and the Americas (aOR 0.59; 95% CI 0.43-0.80); speaking a South Asian language (aOR 0.65; 95% CI 0.51-0.83); and hospital presentation in summer (aOR 0.90; 95% CI 0.82-0.99).

EMS use was lower in patients with ACS with CALD backgrounds. Our findings have identified CALD population subgroups to target with education.