Prehospital 12-Lead ECG Use for Suspected Acute Coronary Syndrome Varies by Community Social Vulnerability

To examine the association of community-level social drivers of health with variability in the documentation of prehospital 12-lead electrocardiogram (ECG) for patients with suspected acute coronary syndrome (ACS).

This retrospective observational cohort study was conducted using the 2021 ESO Data Collaborative with de-identified records from more than 1,300 emergency medical services (EMS) agencies in the United States. We included 9-1-1 ground responses for adults ≥35 years with a prehospital clinical impression of ACS who were transported to the hospital. Social vulnerability index (SVI) was linked at the Census tract of the scene encounter and grouped in quartiles with the highest quartile representing communities of greatest vulnerability. The primary outcome was documentation of prehospital 12-lead ECG performance. Multivariable logistic regression models were used to examine the association of SVI with prehospital 12-lead ECG documentation of performance.

Among 34,388 EMS encounters for patients with suspected ACS, 73% were between the ages of 45-79 years old, 49% were female, and 18% were Black. Most calls occurred in the South (64%), with a paramedic crew (90%), and 29% were in rural settings. Compared to communities in the least vulnerable quartile, Q2 (OR 0.86, 95%CI 0.78-0.95, p = 0.004), Q3 (OR 0.64, 95%CI 0.58-0.71, p < 0.001), and Q4 (OR 0.63, 95%CI 0.57-0.70, p < 0.001) quartiles were associated with reduced odds of ECG documentation. The relationship persisted after adjusting for factors associated with 12-lead ECG documentation.

Higher community social vulnerability was significantly associated with lower odds of prehospital ECG for patients with suspected ACS, suggesting that additional resources focused on these communities may be needed to address these inequities.