Elapsed time in emergency medical services for patients with cardiac complaints are some patients at greater risk for delay?

Thomas W. Concannon, John L. Griffith, David M. Kent, Sharon Lise Normand, Joseph P. Newhouse, James M Atkins, Joni R. Beshansky, Harry P. Selker

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: In patients with a major cardiac event, the first priority is to minimize time to treatment. For many patients, first contact with the health system is through emergency medical services (EMS). We set out to identify patient-level and neighborhood-level factors that were associated with elapsed time in EMS. Methods and Results: A retrospective cohort study was conducted in 10 municipalities in Dallas County, Tex, from January 1 through December 31, 2004. The data set included 5887 patients with suspected cardiac-related symptoms. The region was served by 29 hospitals and 98 EMS depots. Multivariate models included measures of distance traveled, time of day, day of week, and patient and neighborhood characteristics. The main outcomes were elapsed time in EMS (continuous; in minutes) and delay in EMS (dichotomous; >15 minutes beyond median elapsed time). We found positive associations between patient characteristics and both average elapsed time and delay in EMS care. Variation in average elapsed time was not large enough to be clinically meaningful. However, approximately 11% (n=647) of patients were delayed ≥15 minutes. Women were more likely to be delayed (adjusted odds ratio, 1.52; 95% confidence interval, 1.32 to 1.74), and this association did not change after adjusting for other characteristics, including neighborhood socioeconomic composition. Conclusions: Compared with otherwise similar men, women have 50% greater odds of being delayed in the EMS setting. The determinants of delay should be a special focus of EMS studies in which time to treatment is a priority.

Original languageEnglish (US)
Pages (from-to)9-15
Number of pages7
JournalCirculation: Cardiovascular Quality and Outcomes
Volume2
Issue number1
DOIs
StatePublished - Jan 2009

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Emergency Medical Services
Cohort Studies
Retrospective Studies
Odds Ratio
Confidence Intervals
Health
Therapeutics

Keywords

  • Heart diseases
  • Patients
  • Population
  • Women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Elapsed time in emergency medical services for patients with cardiac complaints are some patients at greater risk for delay? / Concannon, Thomas W.; Griffith, John L.; Kent, David M.; Normand, Sharon Lise; Newhouse, Joseph P.; Atkins, James M; Beshansky, Joni R.; Selker, Harry P.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 2, No. 1, 01.2009, p. 9-15.

Research output: Contribution to journalArticle

Concannon, Thomas W. ; Griffith, John L. ; Kent, David M. ; Normand, Sharon Lise ; Newhouse, Joseph P. ; Atkins, James M ; Beshansky, Joni R. ; Selker, Harry P. / Elapsed time in emergency medical services for patients with cardiac complaints are some patients at greater risk for delay?. In: Circulation: Cardiovascular Quality and Outcomes. 2009 ; Vol. 2, No. 1. pp. 9-15.
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abstract = "Background: In patients with a major cardiac event, the first priority is to minimize time to treatment. For many patients, first contact with the health system is through emergency medical services (EMS). We set out to identify patient-level and neighborhood-level factors that were associated with elapsed time in EMS. Methods and Results: A retrospective cohort study was conducted in 10 municipalities in Dallas County, Tex, from January 1 through December 31, 2004. The data set included 5887 patients with suspected cardiac-related symptoms. The region was served by 29 hospitals and 98 EMS depots. Multivariate models included measures of distance traveled, time of day, day of week, and patient and neighborhood characteristics. The main outcomes were elapsed time in EMS (continuous; in minutes) and delay in EMS (dichotomous; >15 minutes beyond median elapsed time). We found positive associations between patient characteristics and both average elapsed time and delay in EMS care. Variation in average elapsed time was not large enough to be clinically meaningful. However, approximately 11{\%} (n=647) of patients were delayed ≥15 minutes. Women were more likely to be delayed (adjusted odds ratio, 1.52; 95{\%} confidence interval, 1.32 to 1.74), and this association did not change after adjusting for other characteristics, including neighborhood socioeconomic composition. Conclusions: Compared with otherwise similar men, women have 50{\%} greater odds of being delayed in the EMS setting. The determinants of delay should be a special focus of EMS studies in which time to treatment is a priority.",
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