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Factors that influence the use of ambulance in acute coronary syndrome
Örebro University, School of Health and Medical Sciences.
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2008 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 156, no 1, p. 170-176Article in journal (Refereed) Published
Abstract [en]

Background

National guidelines recommend activation of the emergency medical service by patients who have symptoms of acute coronary syndrome (ACS). In spite of this, only 50% to 60% of persons with myocardial infarction initiate care by using the emergency medical service. The aim of this study was to define factors influencing the use of ambulance in ACS.

Methods

The method used in this study was a national survey comprising intensive cardiac care units at 11 hospitals in Sweden; 1,939 patients with diagnosed ACS and symptom onset outside the hospital completed a questionnaire a few days after admission.

Results

Half of the patients went to the hospital by ambulance. Factors associated with ambulance use were knowledge of the importance of quickly seeking medical care and calling for an ambulance when having chest pain (odds ratio [OR] 3.61, 95% CI 2.43-5.45), abrupt onset of pain reaching maximum intensity within minutes (OR 2.08, 1.62-2.69), nausea or cold sweat (OR 2.02, 1.54-2.65), vertigo or near syncope (OR 1.63, 1.21-2.20), ST-elevation ACS (OR 1.58, 1.21-2.06), increasing age (per year) (OR 1.03, 1.02-1.04), previous history of heart failure (OR 2.48, 1.47-4.26), and distance to the hospital of >5 km (OR 2.0, 1.55-2.59). Those who did not call for an ambulance thought self-transport would be faster or did not believe they were sick enough.

Conclusions

Symptoms, patient characteristics, ACS characteristics, and perceptions and knowledge were all associated with ambulance use in ACS. The fact that knowledge increases ambulance use and the need for behavioral change pose a challenge for health-care professionals.

Place, publisher, year, edition, pages
Amsterdam: Elsevier , 2008. Vol. 156, no 1, p. 170-176
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems Anesthesiology and Intensive Care
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:oru:diva-3378DOI: 10.1016/j.ahj.2008.01.020PubMedID: 18585513OAI: oai:DiVA.org:oru-3378DiVA, id: diva2:137675
Available from: 2008-12-03 Created: 2008-12-03 Last updated: 2017-12-14Bibliographically approved
In thesis
1. The initial phase of an acute coronary syndrome: symptoms, patients' response to symptoms and opportunity to reduce time to seek care and to increase ambulance use
Open this publication in new window or tab >>The initial phase of an acute coronary syndrome: symptoms, patients' response to symptoms and opportunity to reduce time to seek care and to increase ambulance use
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aims to describe the initial phase of an acute coronary syndrome (ACS) in overall terms from a national perspective and to evaluate the impact of an information campaign designed to inform the public about how to act when suspecting an ACS. A total of 1939 patients at 11 hospitals in Swedenwith diagnosed ACS and symptom onset outside hospital completed a questionnaire(I-IV).In Study V, a questionnaire was completed by 116 patients withACS before the campaign and 122 after it. Register data were followed every year to evaluate ambulance use and emergency department (ED) visits.

With regard to symptoms, patients with ST-elevation ACS (STE-ACS) more frequently had associated symptoms and pain with an abrupt onset reaching maximum intensity within minutes. However, fewer than half the patients with STE-ACS had this type of symptom onset. There were more similarities than differences between genders and differences between age groups were minor (I).

Three-quarters of the patients interpreted the symptoms as cardiac in origin. The majority contacted a family member after symptom onset, whereas few called directly for an ambulance. Approaching someone after symptom onset and the belief that the symptoms were cardiac in origin were factors associated with a shorter pre-hospital delay (II).

Half the patients went to hospital by ambulance. Independent factors for ambulance use were knowledge of the importance of quickly seeking medical care and calling for an ambulance when experiencing chest pain, severe symptoms, abrupt onset of pain, STE-ACS, increasing age and distance to hospital of > 5 km. Reasons for not calling for an ambulance were thinking self-transport would be faster or not being ill enough (III). Pain with abrupt onset, STE-ACS, symptoms such as vertigo or near syncope, experiencing the pain as frightening, interpreting the pain as cardiac in origin and knowledge were major factors associated with a short delay between symptom onset and decision to seek medical care, patient decision time (IV).

The information campaign did not result in a reduction in patient decision time, but it appeared to increase ambulance use and the number of patients seeking the ED for acute chest pain (V).

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 75
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 67
Keywords
Acute coronary syndrome, pre-hospital delay, ambulance use, symptoms, decision making
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Research subject
Medicine; Cardiology
Identifiers
urn:nbn:se:oru:diva-21672 (URN)978-91-7668-859-5 (ISBN)
Public defence
2012-03-16, Wilandersalen, Universitetssjukhuset, Örebro, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2012-02-16 Created: 2012-02-16 Last updated: 2017-10-17Bibliographically approved

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Publisher's full textPubMedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=18585513&dopt=Citation

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Thuresson, Marie

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