Usage of ambulance transport and influencing factors in acute coronary syndrome: a cross-sectional study at a tertiary centre in China

Abstract

ObjectivesThe aim of this study was to explore the choice of transportation mode to hospital in patients with acute coronary syndrome (ACS) and to determine the factors influencing the use of ambulance.Design, setting and participantsThis cross-sectional study was conducted in a tertiary and teaching hospital in China. The study was carried out between 24 August 2015 and 24 July 2016. A total of 828 patients with ACS presented at the emergency department (ED) were included. The study population was dichotomised according to their primary mode of transport (ambulance or self-transport) to hospital. Social demographics, cardiovascular history, risk factors, prehospital medications, clinical characteristics and symptom characteristics were collected. Multivariable logistic regression was used to examine the factors associated with ambulance use.ResultsWe found that only 179 (21.6%) patients with ACS chose taking ambulance to hospital. Factors associated with ambulance use were single (OR 1.66, 95% CI 1.07 to 2.57), taking Suxiaojiuxin pills (OR 1.91, 1.31 to 2.80) or nitrates (OR 2.91, 1.70 to 4.99) before going to hospital, diagnosed as ST-elevation myocardial infarction (STEMI) (OR 2.43, 1.45 to 4.05), with persistent symptoms (OR 1.95, 1.33 to 2.86) and symptoms accompanied with vomiting (OR 2.35, 1.19 to 4.62). The patients who had symptoms precipitated or aggravated by exercise (OR 0.37, 0.14 to 0.98) tended to choose self-transport.ConclusionThe usage of ambulance in patients with ACS presenting to the ED was low in China. Factors like single, taking Suxiaojiuxin pills or nitrates before going to hospital, diagnosed as STEMI, accompanied with vomiting and persistent symptoms were independently associated with ambulance use. Future education programmes should focus on these factors and increase people’s knowledge on ACS and the benefits of ambulance use.

Pre-hospital delay and emergency medical services in acute myocardial infarction

“…However, the data presented here showed that direct visits to PCI centres (28%) or transfers from non-PCI centres (50.3%) were more frequent, and utilisation of EMS (21.7%) was less frequent than that seen in previous studies conducted in Western countries [29,34,35]. Despite frequencies similar to those of other Asian countries [36,37], a significant need to identify predictors of non-utilisation of EMS among STEMI patients remains. Although certain clinical variables have been linked to non-use of EMS services, these results remain controversial [36][37][38][39].…”

“…Despite frequencies similar to those of other Asian countries [36,37], a significant need to identify predictors of non-utilisation of EMS among STEMI patients remains. Although certain clinical variables have been linked to non-use of EMS services, these results remain controversial [36][37][38][39]. In accordance with other studies, old age was not shown to be an independent factor for non-utilisation of EMS.…”

The application of optimisation modelling and geospatial analysis to propose a coronary care network model for patients with ST-elevation myocardial infarction

“…This contributes to significant delays in PCI [ 12 ]. Low rates of ambulance utilisation in myocardial infarction have also been described in China [ 15 ], Ireland [ 16 ], and the United States [ 17 ]. For this reason, public education campaigns should highlight the importance of ambulance transport.…”

The individual and neighborhood factors associated with the use of emergency medical services in patients with ST-elevation myocardial infarction

“…Consistent with previous studies, we found that the more severe the symptoms of STEMI were, the higher was the rate of EMS use. 24 Some studies have evaluated the association between EMS use and past medical history. 11,24 This study showed that patients with STEMI who had a history of coronary artery disease were much more likely to use EMS (odds ratio, 2.47) compared to those without a history of coronary artery disease.…”