Equity-Related Factors in Emergency Medical Service Use for Acute Coronary Syndromes: A Systematic Review

Emergency medical service (EMS) use reduces time to treatment and improves outcomes in acute coronary syndrome (ACS), yet it is unknown whether all Australians have equitable access to EMS. This systematic review examined whether equity-related factors are associated with disparities in EMS use for patients with ACS in Australia.

The review was pre-registered with PROSPERO (CRD42023466951). Six databases (MEDLINE, CINAHL, Web of Science, ScienceDirect, Cochrane and Scopus) were searched in June 2025 for articles published from inception until May 2025. Eligible studies involved adults presenting to Australian hospitals or emergency departments with ACS or acute non-traumatic chest pain and reported EMS use by at least one PROGRESS-Plus equity-related factor. Risk of bias was assessed using JBI checklists. Findings were synthesized using tabular analysis and a vote-counting summary.

Fourteen studies were identified, with twelve rated high quality. EMS utilization ranged from 36% to 79% and increased over time. Disparities were evident across multiple equity-related factors. Adults aged under 49 years had up to 68% lower odds of EMS use than those 65 years or older. Men had up to 11% lower odds than women. People born outside Australia had up to 15% lower odds, and those preferring non-English languages had 6-20% lower odds. Residents of remote areas had up to 25% lower odds than major city residents, while individuals living alone had up to 48% higher odds than those living with others. Findings for socioeconomic status measures were mixed.

EMS use for ACS in Australia is consistently lower among younger adults, men, people born overseas, those preferring non-English languages, and residents of remote areas. These findings can inform targeted interventions to improve EMS accessibility. Future research should examine the mechanisms underlying these access barriers, particularly for populations experiencing multiple forms of disadvantage.