Use of emergency medical services in acute myocardial infarction and subsequent quality of care

Abstract

The purpose of this review is to examine the use of the emergency medical services in acute myocardial infarction, ascertain the factors that may influence emergency medical services use by patients, and evaluate how emergency medical services use may affect subsequent quality of care. This review summarizes a report published by the National Registry of Myocardial Infarction. From June 1994 to March 1998, the National Registry of myocardial Infarction 2 enrolled 772,586 patients with Myocardial infarction. Our study excluded those who were transferred in, those who arrived at the hospital >6 hours from symptom onset, and those who were in cardiogenic shock. Emergency medical services were used by 53.4% of patients with myocardial infarction, a proportion that did not vary over the 4-year period. Nonusers were on average younger, male, and at relatively lower risk on presentation. The use of emergency medical services was significantly associated with greater use of reperfusion therapies and faster time to treatment, fibrinolytic therapy (12.1 minutes faster, p<0.001), or percutaneous transluminal coronary angioplasty (31.2 minutes faster, p<0.001). Wider use of emergency medical services by patients with suspected myocardial infarction may offer significant improvements in public health. © 2003 CVRR, Inc.