224 - Emergency Medical Services Activation for Heart Failure Patients: A Methodological Pilot Study

Abstract

Introduction: Little is known about the actual events, signs, and symptoms of heart failure (HF) patients that occur immediately before and during emergency medical services (EMS) activation. Aims: Aims were to: 1) validate a standard coding method to categorize the events, signs, and symptoms experienced by HF patients immediately before and during EMS activation; and 2) categorize types and frequencies of events, signs, and symptoms reported by HF patients before and during EMS activation. Methods: Content analysis was used to analyze data obtained from audiofiles in an EMS database in a large Midwestern city. Inclusion criteria were: 1) HF diagnosis, 2) EMS activated by 911 call, and 3) transported to hospital. A four-step analysis process was used. First, data were transcribed verbatim from audiofiles into narrative transcripts and verified for accuracy. Second, two team members read the narrative transcripts, independently developed coding themes for events, signs, and symptoms and documented other insights and reflections. Third, two team members reviewed the coding themes together and came to consensus on data categorization. Fourth, all data were re-validated using the standard coding. Results: Coding themes were developed and validated in a sample of 30 EMS audiofiles from 25 HF patients (44% women, mean age 58.6 ± 17.5 yrs; 64% African American, 36% White; 100% non-Hispanic). Of the 25 patients, 18 had more than 1 reason for EMS activation. Eight types of events, 12 signs, and 5 symptoms were identified. The most frequent event reported was fall, which occurred in 20% of patients. The most frequent signs were decreased level of consciousness (20%), bleeding (16%), injury (16%), and decreased oxygen saturation (12%). The most frequent symptoms were shortness of breath (40%) and pain (24%). Shortness of breath was most frequently reported of all events, signs, and symptoms. Conclusions: The validated coding will be used to analyze a larger set of 300 audiofiles. The findings will be used to construct a conceptual framework representing events, signs, and symptoms of HF patients immediately before and during EMS activation which can be used to design testable interventions to reduce signs and symptoms of HF and unnecessary hospitalizations.