Acute Care/Hospitalization

Heart attack victims should use emergency transport services, not self or family to get to the hospital

When a patient recognizes that they are having a heart attack (acute myocardial infarction [MI]), they should call 911 for emergency medical services (EMS), rather than driving themselves to the hospital or asking a friend or relative to do so, recommends a new study. Patients with certain types of MI, particularly those with ST-segment-elevation MI (STEMI), are known to have lower rates of sickness and death when restoration of blocked blood flow to the heart (reperfusion) occurs early. For example, this study of 18,069 STEMI patients treated at 296 hospitals found that only 61 percent of these patients were transported to the hospital by EMS while 39 percent were self-transported. Patients taken to the hospital by EMS transport vehicles had significantly shorter delays than self-transported patients from symptom onset to arrival time (median of 89 vs. 120 minutes) and to the beginning of reperfusion once they arrived (63 vs. 76 minutes).

Self-transported STEMI patients who did not have contraindications to reperfusion were 23 percent less likely to receive reperfusion therapy than were EMS-transported patients. They were also 48 percent less likely to receive an initial electrocardiogram within 10 minutes of arrival and 57 percent less likely to undergo coronary angioplasty within 90 minutes of arrival.

The researchers identified the study population from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network (ACTION) Registry—Get with the Guidelines (GWTG), and collected patient data from the participating hospitals. The study was funded in part by the Agency for Healthcare Research and Quality (HS16964).

More details are in "Use of Emergency Medical Service transport among patients with ST-segment-elevation myocardial infarction: Findings from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry—Get With the Guidelines," by Robin Mathews, M.D., Eric D. Peterson, M.D., M.P.H., Shuang Li, M.S., and others in the July 2011 Circulation 124(2), pp. 154-163.

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