Prehospital system delay in ST-segment elevation myocardial infarction care: A novel linkage of emergency medicine services and inhospital registry data

doi:10.1016/j.ahj.2012.11.003

American Heart Journal

Volume 165, Issue 3, March 2013, Pages 363-370

https://doi.org/10.1016/j.ahj.2012.11.003 Get rights and content

Background

Emergency medical services (EMS) are critical in the treatment of ST-segment elevation myocardial infarction (STEMI). Prehospital system delays are an important target for improving timely STEMI care, yet few limited data are available.

Methods

Using a deterministic approach, we merged EMS data from the North Carolina Pre-hospital Medical Information System (PreMIS) with data from the Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments—Emergency Response (RACE-ER) Project. Our sample included all patients with STEMI from June 2008 to October 2010 who arrived by EMS and who had primary percutaneous coronary intervention (PCI). Prehospital system delays were compared using both RACE-ER and PreMIS to examine agreement between the 2 data sources.

Results

Overall, 8,680 patients with STEMI in RACE-ER arrived at a PCI hospital by EMS; 21 RACE-ER hospitals and 178 corresponding EMS agencies across the state were represented. Of these, 6,010 (69%) patients were successfully linked with PreMIS. Linked and notlinked patients were similar. Overall, 2,696 patients were treated with PCI only and were taken directly to a PCI-capable hospital by EMS; 1,750 were transferred from a non-PCI facility. For those being transported directly to a PCI center, 53% reached the 90-minute target guideline goal. For those transferred from a non-PCI facility, 24% reached the 120-minute target goal for primary PCI.

Conclusions

We successfully linked prehospital EMS data with inhospital clinical data. With this linked STEMI cohort, less than half of patients reach goals set by guidelines. Such a data source could be used for future research and quality improvement interventions.

Section snippets

Design and data sources

We used data from 2 sources to gain prehospital and inhospital data on patients with STEMI. Prehospital data were obtained from the statewide PreMIS database, which contains tools for data entry, reporting, and evaluation of EMS quality and performance. Submission to PreMIS is mandatory for all EMS providers in NC. The data set is based on the National EMS Information System, which is currently used widely throughout the United States. In 2008, PreMIS collected 1,200,000 EMS records,

Evaluation of the linkage

Data were used from all 21 RACE hospitals and 178 corresponding EMS agencies across NC (Figure 1). Of the 8,680 patients with STEMI in RACE who arrived at the PCI hospital by EMS, 6,010 (69%) were successfully linked with PreMIS. Linked and notlinked patients were similar in terms of baseline characteristics and comorbidities (Table I). The primary reasons for nonlinkage included the following: incorrect or missing birth date in PreMIS (12% of all PreMIS records), hospital name spelled

Discussion

We successfully linked prehospital and acute care inhospital registry data for nearly 70% of patients with STEMI in NC. Our study resulted in 3 main findings. First, our linkage required substantial manual standardization of destination names. Second, less than half of all patients reached the quality metric of 90 minutes from FMC to PCI for patients transported directly to a PCI center. Third, the time from FMC to PCI among patients who were transferred to PCI from an interim hospital was

Limitations of the study

Our study had several limitations. First, data were linked using indirect identifiers; therefore, approximately 30% of our sample was excluded. However, generalizability was retained because linked and nonlinked patients had similar characteristics and treatment times. Importantly, a previous deterministic linkage between PreMIS data and stroke registry data using similar methodology was validated using manual chart review and found to be highly accurate (>90%).⁹ Second, study inclusion was

Acknowledgements

The authors would like to thank Erin LoFrese for editorial assistance with this manuscript.

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: Timothy D. Henry, MD served as guest editor for this article.

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Clinical InvestigationAcute Ischemic Heart DiseasePrehospital system delay in ST-segment elevation myocardial infarction care: A novel linkage of emergency medicine services and inhospital registry data

Background

Methods

Results

Conclusions

Section snippets

Design and data sources

Evaluation of the linkage

Discussion

Limitations of the study

Acknowledgements

J Am Coll Cardiol

Am Heart J

Am Heart J

JACC Cardiovasc Interv

Circulation

Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology

Eur Heart J

A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction

Circulation

Regional systems of care for patients with ST-elevation myocardial infarction: being at the right place at the right time

Circulation

Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts

Circulation

Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty

Eur Heart J

Clinical Investigation
Acute Ischemic Heart Disease
Prehospital system delay in ST-segment elevation myocardial infarction care: A novel linkage of emergency medicine services and inhospital registry data