Abstract
Method: A prospective observational study of prehospital times and events was undertaken on a target population of patients presenting with acute chest pain attributable to an acute coronary syndrome over a three month period.
Results: Patients who decided to call the ambulance service were compared with patients who contacted any other service. Most patients who contact non-ambulance services are seen by general practitioners. The prehospital system time for 121 patients who chose to call the ambulance service first was significantly shorter than for 96 patients who chose to call another service (median 57 min v 107 min; p<0.001). Of the 42 patients thrombolysed in the emergency department, those who chose to call the ambulance service had significantly shorter prehospital system times (number 21 v 21; median 44 v 69 min; p<0.001). Overall time from pain onset to initiation of thrombolysis was significantly longer in the group of patients who called a non-ambulance service first (median 130 min v 248 min; p=0.005).
Conclusions: Patient with acute ischaemic chest pain who call their general practice instead of the ambulance service are likely to have delayed thrombolysis. This is likely to result in increased mortality. The most beneficial current approach is for general practices to divert all patients with possible ischaemic chest pain onset within 12 hours direct to the ambulance service.
Full Text
The Full Text of this article is available as a PDF (109.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Castiella J., Valdearcos S., Alquezar M. L. Análisis de las causas que motivan una excesiva demora prehospitalaria de pacientes con infarto agudo de miocardio en la provincia de Teruel. Rev Esp Cardiol. 1997 Dec;50(12):860–869. doi: 10.1016/s0300-8932(97)74693-1. [DOI] [PubMed] [Google Scholar]
- Foster S., Mallik M. A comparative study of differences in the referral behaviour patterns of men and women who have experienced cardiac-related chest pain. Intensive Crit Care Nurs. 1998 Aug;14(4):192–202. doi: 10.1016/s0964-3397(98)80525-9. [DOI] [PubMed] [Google Scholar]
- Gaspoz J. M., Unger P. F., Urban P., Chevrolet J. C., Rutishauser W., Lovis C., Goldman L., Héliot C., Séchaud L., Mischler S. Impact of a public campaign on pre-hospital delay in patients reporting chest pain. Heart. 1996 Aug;76(2):150–155. doi: 10.1136/hrt.76.2.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Herlitz J., Bång A., Isaksson L., Karlsson T. Ambulance despatchers' estimation of intensity of pain and presence of associated symptoms in relation to outcome in patients who call for an ambulance because of acute chest pain. Eur Heart J. 1995 Dec;16(12):1789–1794. doi: 10.1093/oxfordjournals.eurheartj.a060829. [DOI] [PubMed] [Google Scholar]
- Ho M. T., Eisenberg M. S., Litwin P. E., Schaeffer S. M., Damon S. K. Delay between onset of chest pain and seeking medical care: the effect of public education. Ann Emerg Med. 1989 Jul;18(7):727–731. doi: 10.1016/s0196-0644(89)80004-6. [DOI] [PubMed] [Google Scholar]
- Morrison L. J., Verbeek P. R., McDonald A. C., Sawadsky B. V., Cook D. J. Mortality and prehospital thrombolysis for acute myocardial infarction: A meta-analysis. JAMA. 2000 May 24;283(20):2686–2692. doi: 10.1001/jama.283.20.2686. [DOI] [PubMed] [Google Scholar]
- Moser D. K., Dracup K. Gender differences in treatment-seeking delay in acute myocardial infarction. Prog Cardiovasc Nurs. 1993 Summer;8(1):6–12. [PubMed] [Google Scholar]
- Pettersen K. I. When time is precious--time lags as indicators of quality of care in acute myocardial infarction. Int J Qual Health Care. 1995 Mar;7(1):3–10. doi: 10.1093/intqhc/7.1.3. [DOI] [PubMed] [Google Scholar]
- Rawles J. Magnitude of benefit from earlier thrombolytic treatment in acute myocardial infarction: new evidence from Grampian region early anistreplase trial (GREAT) BMJ. 1996 Jan 27;312(7025):212–215. doi: 10.1136/bmj.312.7025.212. [DOI] [PMC free article] [PubMed] [Google Scholar]