Abstract
(1) Introduction: Most studies rely on in-hospital data to predict cardiovascular risk and do not include prehospital information that is substantially important for early decision making. The aim of the study was to define clinical parameters in the prehospital setting, which may affect clinical outcomes. (2) Methods: In this population-based study, we performed a retrospective analysis of emergency calls that were made by patients to the largest private emergency medical services (EMS) in Israel, SHL Telemedicine Ltd., who were treated on-site by the EMS team. Demographics, clinical characteristics, and clinical outcomes were analyzed. Mortality was evaluated at three time points: 1, 3, and 12 months’ follow-up. The first EMS prehospital measurements of the systolic blood pressure (SBP) were recorded and analyzed. Logistic regression analyses were performed. (3) Results: A total of 64,320 emergency calls were included with a follow-up of 12 months post index EMS call. Fifty-five percent of patients were men and the mean age was 70.2 ± 13.1 years. During follow-up of 12 months, 7.6% of patients died. Age above 80 years (OR 3.34; 95% CI 3.03–3.69, p < 0.005), first EMS SBP ≤ 130 mm Hg (OR 2.61; 95% CI 2.36–2.88, p < 0.005), dyspnea at presentation (OR 2.55; 95% CI 2.29–2.83, p < 0001), and chest pain with ischemic ECG changes (OR 1.95; 95% CI 1.71–2.23, p < 0.001) were the highest predictors of 1 month mortality and remained so for mortality at 3 and 12 months. In contrast, history of hypertension and first EMS prehospital SBP ≥ 160 mm Hg were significantly associated with decreased mortality at 1, 3 and 12 months. (4) Conclusions: We identified risk predictors for all-cause mortality in a large cohort of patients during prehospital EMS calls. Age over 80 years, first EMS-documented prehospital SBP < 130 mm Hg, and dyspnea at presentation were the most profound risk predictors for short- and long-term mortality. The current study demonstrates that in prehospital EMS call settings, several parameters can be used to improve prioritization and management of high-risk patients.
Highlights
The prehospital environment provides immediate and essential care for patients with life-threatening cardiovascular conditions such as cardiovascular death, myocardial infarction, heart failure (HF), exacerbation, or stroke
First emergency medical services (EMS) systolic blood pressure (SBP) < 130 mm Hg was a strong predictor of mortality at 1 month with an Odds ratio (OR) of 2.6; at 3 months, an OR of 2.34; and at 1 year, an OR of 1.96
The study results demonstrated that age > 80 years and first EMS SBP < 130 mm Hg have a significant negative effect on mortality, in the prehospital setting
Summary
The prehospital environment provides immediate and essential care for patients with life-threatening cardiovascular conditions such as cardiovascular death, myocardial infarction, heart failure (HF), exacerbation, or stroke. Patients requiring prehospital care are generally those who acquire an emergency medical services (EMS) plan, essential for the patients’ health and well-being. As such, these patients do not represent the general population’s medical background, but rather a sector with high cardiovascular risk, high socioeconomic status, and prior comorbid conditions or previous hospitalizations, and signify the scope of this paper. These patients do not represent the general population’s medical background, but rather a sector with high cardiovascular risk, high socioeconomic status, and prior comorbid conditions or previous hospitalizations, and signify the scope of this paper For these patients, fully disclosed information, including all medications, is readily available to the dispatch team and hospital staff. There is considerable competing information regarding which prediction models should be used or recommended [2,3]
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