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Use of emergency medical service in acute myocardial infarction in an Italian Northeastern region

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Abstract

Aim

This study aimed at assessing emergency medical service (EMS) use by patients with acute myocardial infarction (AMI), factors associated with EMS use, and outcomes in the 1,200,000-inhabitant Italian region of Friuli Venezia Giulia.

Subject and methods

Anonymous health administrative databases were analyzed from 2010 to 2019. EMS use was assessed from Emergency Department and hospital discharge data for patients discharged with main diagnosis of AMI (ICD-9-CM 410.×1). Factors associated with EMS, likelihood of undergoing a primary percutaneous coronary intervention (pPCI) and of 30-day mortality were assessed in univariate and multivariate analyses.

Results

In 10 years, 14,900 AMI patients were hospitalized. Only half used EMS, with no changes over time. Demographic and residential factors and comorbidities affected EMS use. Although patients transported by EMS had increased 30-day mortality, undergoing pPCI decreased mortality significantly (in STEMI, OR 0.41).

Conclusion

In this region, patients transported by EMS had increased mortality, probably because of residual confounding due to AMI severity; however, undergoing pPCI halved mortality. EMS use has not increased over time and was not uniform across the region. This finding emphasizes the need of population campaigns covering all the regional geographic areas. The importance of transporting patients by EMS directly to PCI facilities should be stressed.

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Funding

This work was partly financed by the Italian Ministry of Health and the Friuli Venezia Giulia Region (Grant NET-2016-02364191).

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Authors and Affiliations

  1. Institute of Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Friuli Centrale, Via Colugna 50, 33100, Udine, Italy

    Francesca Valent

  2. Cardiology, Azienda Sanitaria Universitaria Friuli Centrale, 33013, Gemona del Friuli, Italy

    Antonio Di Chiara

Authors
  1. Francesca Valent
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  2. Antonio Di Chiara
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Correspondence to Francesca Valent.

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The authors report no conflict of interest.

Research involving human participants and/or animals

All procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Since this analysis was based on anonymous administrative data with no possibility to identify subjects, Ethical Committee approval was not required in Italy.

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Since the data were completely anonymous, informed consent was nor applicable.

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Valent, F., Di Chiara, A. Use of emergency medical service in acute myocardial infarction in an Italian Northeastern region. J Public Health (Berl.) 30, 1523–1531 (2022). https://doi.org/10.1007/s10389-020-01422-9

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  • DOI: https://doi.org/10.1007/s10389-020-01422-9

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