Full Text Available
Note: Clicking the button above will open the full text document at the original institutional repository in a new window.
Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes
Introduction: Acute coronary syndromes, including ST-elevation myocardial infarction (STEMI), are a leading cause of morbidity and mortality worldwide. Existing research shows that prehospital care provided by emergency medical services (EMS) can significantly improve outcomes. However, EMS remains...
Saved in:
| Main Author: | |
|---|---|
| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
Division of Emergency Medicine
2017
|
| Subjects: | |
| Tags: |
No Tags, Be the first to tag this record!
|
| _version_ | 1867613316589813760 |
|---|---|
| access_status_str | Open Access |
| author | Callachan, Edward |
| author2 | Wallis, Lee A |
| author_browse | Callachan, Edward Wallis, Lee A |
| author_facet | Wallis, Lee A Callachan, Edward |
| author_sort | Callachan, Edward |
| collection | Thesis |
| description | Introduction: Acute coronary syndromes, including ST-elevation myocardial infarction (STEMI), are a leading cause of morbidity and mortality worldwide. Existing research shows that prehospital care provided by emergency medical services (EMS) can significantly improve outcomes. However, EMS remains grossly underutilised in Abu Dhabi despite a well-established presence. Objectives: In this three-part quantitative, observational study, we sought to (1) assess physicians' perceptions of, and recommendations for, utilization and improvement of EMS, (2) assess patients' awareness of EMS, mode of transport use in decision to seek care and reasons for their decision, and (3) establish if in the current study setting, mode of transport used has implications for in hospital adverse events, as well as short and long term clinical outcomes. The goal was to investigate both physicians' and patients' perceptions of prehospital STEMI care, as well as to assess the clinical correlates of the mode of transport in a patient's decision to seek care. Methods: We conducted the study in three phases. Phase 1: At four government-operated hospitals in Abu Dhabi, we administered surveys to a convenience sample of physicians involved in care of patients with acute coronary syndromes to measure (a) likelihood of recommending EMS, (b) satisfaction with EMS, (c) likelihood of using EMS for self or family, and (d) recommendations for prehospital care of acute coronary syndromes. Phase 2: We gathered mode of transport data from a purposive, non-random sample of 587 consecutive patients with STEMI over an 18-month period and conducted structured follow-up interviews to assess their perceptions of EMS. We conducted analysis to determine whether mode of transport was related to demographic variables. Phase 3: We collected medical records from patient participants and conducted structured follow-up interviews at 1, 6 and 12 months post discharge. We conducted chi square difference testing to determine the relationships among mode of transport, treatment times, and short- and long-term clinical outcomes. Variables included treatment times and associated outcomes. Results: Physician participants (n = 106) were most supportive of prehospital 12-lead ECG for STEMI, but indicated low satisfaction with existing EMS services in Abu Dhabi. Among STEMI patient participants (n = 587), EMS was underutilized in Abu Dhabi; over half (55%) of patients did not know the phone number to contact EMS, and only 14.7% used EMS in their decision to seek care. EMS-transported patients were more likely to receive timely treatment (door-todiagnostic ECG time, door-to-balloon time) and had lower incidence of mortality compared to privately-transported patients. Conclusions: These findings suggest a need to raise public awareness of EMS and its importance for coronary symptoms in Abu Dhabi. Broader application of prehospital ECG, including prehospital activation of cardiac catheterization labs, bypassing non-interventional cardiology centres, and admission directly to facilities that provide these services without initial admission to the emergency department, could help improve physicians' perceptions of EMS and outcomes for patients with STEMI. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/25168 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:34:10.861Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2017 |
| publishDateRange | 2017 |
| publishDateSort | 2017 |
| publisher | Division of Emergency Medicine |
| publisherStr | Division of Emergency Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/25168 Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes Callachan, Edward Wallis, Lee A Emergency Medicine Introduction: Acute coronary syndromes, including ST-elevation myocardial infarction (STEMI), are a leading cause of morbidity and mortality worldwide. Existing research shows that prehospital care provided by emergency medical services (EMS) can significantly improve outcomes. However, EMS remains grossly underutilised in Abu Dhabi despite a well-established presence. Objectives: In this three-part quantitative, observational study, we sought to (1) assess physicians' perceptions of, and recommendations for, utilization and improvement of EMS, (2) assess patients' awareness of EMS, mode of transport use in decision to seek care and reasons for their decision, and (3) establish if in the current study setting, mode of transport used has implications for in hospital adverse events, as well as short and long term clinical outcomes. The goal was to investigate both physicians' and patients' perceptions of prehospital STEMI care, as well as to assess the clinical correlates of the mode of transport in a patient's decision to seek care. Methods: We conducted the study in three phases. Phase 1: At four government-operated hospitals in Abu Dhabi, we administered surveys to a convenience sample of physicians involved in care of patients with acute coronary syndromes to measure (a) likelihood of recommending EMS, (b) satisfaction with EMS, (c) likelihood of using EMS for self or family, and (d) recommendations for prehospital care of acute coronary syndromes. Phase 2: We gathered mode of transport data from a purposive, non-random sample of 587 consecutive patients with STEMI over an 18-month period and conducted structured follow-up interviews to assess their perceptions of EMS. We conducted analysis to determine whether mode of transport was related to demographic variables. Phase 3: We collected medical records from patient participants and conducted structured follow-up interviews at 1, 6 and 12 months post discharge. We conducted chi square difference testing to determine the relationships among mode of transport, treatment times, and short- and long-term clinical outcomes. Variables included treatment times and associated outcomes. Results: Physician participants (n = 106) were most supportive of prehospital 12-lead ECG for STEMI, but indicated low satisfaction with existing EMS services in Abu Dhabi. Among STEMI patient participants (n = 587), EMS was underutilized in Abu Dhabi; over half (55%) of patients did not know the phone number to contact EMS, and only 14.7% used EMS in their decision to seek care. EMS-transported patients were more likely to receive timely treatment (door-todiagnostic ECG time, door-to-balloon time) and had lower incidence of mortality compared to privately-transported patients. Conclusions: These findings suggest a need to raise public awareness of EMS and its importance for coronary symptoms in Abu Dhabi. Broader application of prehospital ECG, including prehospital activation of cardiac catheterization labs, bypassing non-interventional cardiology centres, and admission directly to facilities that provide these services without initial admission to the emergency department, could help improve physicians' perceptions of EMS and outcomes for patients with STEMI. 2017-09-14T12:14:54Z 2017-09-14T12:14:54Z 2017 Doctoral Thesis Doctoral PhD http://hdl.handle.net/11427/25168 eng application/pdf Division of Emergency Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Emergency Medicine Callachan, Edward Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes |
| thesis_degree_str | Doctoral |
| title | Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes |
| title_full | Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes |
| title_fullStr | Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes |
| title_full_unstemmed | Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes |
| title_short | Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes |
| title_sort | mode of transport to hospital among patients with st elevation acute myocardial infarction stemi in the emirate of abu dhabi correlates physician and patient attitudes and associated clinical outcomes |
| topic | Emergency Medicine |
| url | http://hdl.handle.net/11427/25168 |
| work_keys_str_mv | AT callachanedward modeoftransporttohospitalamongpatientswithstelevationacutemyocardialinfarctionstemiintheemirateofabudhabicorrelatesphysicianandpatientattitudesandassociatedclinicaloutcomes |