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IMMEDIATE: Women, elderly most affected by delays in ACS care
Delays occur throughout emergency ACS care, and female and elderly patients are affected the most, according to new findings from the IMMEDIATE trial.
Researchers conducted a retrospective analysis of data from the randomized controlled IMMEDIATE trial, which analyzed emergency medical services (EMS) treatment of people with symptoms suggestive of ACS. In the IMMEDIATE trial, 54,230 adults had out-of-hospital ECGs, 871 of whom had presumed ACS and 303 of whom had STEMI and underwent PCI.
Differences in time intervals
The present analysis focused on difference in time intervals by sex, age, history of CVD and diabetes, race/ethnicity, weekday and time of day. The original study evaluated whether IV glucose-insulin-potassium led to better outcomes in patients with a high suspicion of ACS.
Alison L. Sullivan, MD, of Tufts University School of Medicine, and colleagues measured the following time intervals: from symptom onset to 911 call; from EMS arrival to out-of-hospital ECG; from EMS arrival on scene to EMS departure from scene; and from hospital arrival to balloon inflation. They also calculated the times from medical contact to balloon inflation and from symptom onset to balloon inflation. According to the findings, overall median times were 53 minutes from symptom onset to 911 call, 15.2 minutes from EMS arrival to out-of-hospital ECG, 20 minutes for on-scene time and 62 minutes for door-to-balloon time. Patients with STEMI had median times of 94 minutes from medical contact to PCI and 156 minutes from symptom onset to balloon inflation, the researchers found.
Women waited 28 minutes longer to call 911 (P<.01), patients with diabetes waited 10 minutes longer (P=.03) and those without previous CVD waited 6 minutes longer (P=.02) vs. their counterparts.
Time from EMS arrival to ECG was longer for women (by 1.5 minutes; P<.01), those aged 65 years and older (by 1.3 minutes; P<.01) and those without a primary complaint of chest pain (by 3.5 minutes; P>.01), according to the researchers.
Groups with longer on-scene times included women and those aged at least 65 years (both by 2 minutes; P<.01). The groups with longer door-to-balloon times included those aged at least 65 years (by 10 minutes; P<.01), those presenting on weekends (by 14 minutes; P>.01) and those presenting at night (by 11 minutes; P>.01).
The median time from medical contact to balloon inflation was 106.5 minutes for women vs. 90.5 minutes for men (P=.01), and the median time from symptom onset to balloon inflation was 180 minutes for women vs. 148.5 minutes for men (P=.02). The researchers also found that median time from medical contact to balloon inflation was 9 minutes longer for those aged at least 65 years compared with those aged 55 to 64 years (97 minutes vs. 88 minutes; P<.01).
There were no differences in time intervals by race/ethnicity, but race/ethnicity data were not collected from those who were not at high risk for ACS and did not have STEMI, the researchers wrote.
Need for a comprehensive approach
“These findings indicate the need for a comprehensive approach to improve early detection of ACS, starting with the patients themselves,” Sullivan and colleagues wrote. Only 10% of participants met the American College of Cardiology/American Heart Association guideline to call 911 within 5 minutes of onset of ACS symptoms, they noted.
The other area that could most improve early detection of ACS is faster time from EMS arrival to out-of-hospital ECG; this is a “critical time interval in the diagnosis and management of ACS,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.