Abstract P123: The Introduction of Prehospital ECGs into a Provincial System of STEMI Care: Impact on Treatment Delays and the Process of Care

Abstract

Background: Timely reperfusion therapy is associated with improved clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). To improve treatment delays in Quebec (Canada), the Health Ministry set a goal of implanting prehospital ECG programs in all healthcare regions by the end of 2010. Objective: To investigate treatment delays and processes of care associated with the introduction of prehospital ECG programs in Quebec. Methods: All acute care Quebec hospitals that treated at least 30 acute myocardial infarctions (AMI) (n=82) participated in a systematic 6-month evaluation in 2008-9. Charts, prehospital ECGs and first in-hospital ECGs of all patients with a final diagnosis of AMI who presented to an emergency room with appropriate symptoms were reviewed to identify STEMI. Results: Of 1878 patients with STEMI who either received fibrinolysis or were sent for primary angioplasty (PPCI), 1118 (60%) came by ambulance. Of ambulance patients, 148 (13%) had a prehospital ECG. For 68% of these patients, there was an alert from the ambulance to the first emergency room. The prehospital ECG was transmitted to the first emergency room for 52% (77/148) of patients but a second in-hospital ECG was performed for 95% (141/148) of patients. The majority (61%) of patients with prehospital ECGs were brought directly to a PPCI center. However, almost 25% were brought to a non-PPCI center and then transferred to a PPCI center. In-hospital treatment delays were shorter in prehospital ECG patients without a substantial increase in the prehospital delay. However, even with a prehospital ECG, transferred patients experienced long delays to treatment. Conclusion: These findings suggest that the potential for improving times to treatment by implanting ECG programme depends on modifying the continuum of STEMI care. Specifically, the avoidance of unnecessary and time-consuming inter-hospital transfers should be the primary goal of a prehospital ECG program. Prehospital and in-hospital treatment delays in STEMI patients who presented by ambulance Type of reperfusion treatment Prehospital Delay First medical contact to triage Median (10-90 percentile) In-hospital Delay Triage to treatment Median (10-90 percentile) With prehospital ECG Without prehospital ECG With prehospital ECG Without prehospital ECG Fibrinolysis n=195 38 min (20-56) 28 min (18-50) 19 min (14-55) 29 min (13-73) Direct admission PPCI n=417 30 min (21-51) 29 min (19-45) 57 min (32-95) 78 min (43-170) PPCI with transfer n=506 28 min (17-48) 27 min (18-47) 97 min (69-172) 109 min (75-207)