Logistic features of provision of pre-hospital emergency medical care to elderly patients with acute coronary circulatory disorders

March 12, 2018
734
Resume

The aim of the study — to investigate the logistic features of provision of emergency medical care in elderly patients with acute coronary syndrome. Materials and methods. In a one-center retrospective study, the time intervals of emergency medical care from the onset of symptoms to pre-hospital reperfusion therapy and the hospitalization of 846 elderly patients with acute coronary circulatory disorders were analyzed. The median age of the patients was 73 (33–97) years, of which 504 (59.6%) men and 342 (40.4%) women. Statistical processing of the results was carried out using «MedStat» and «Microsoft Excel» software. Results. It has been established that only 56.5% of the patients with acute coronary syndrome call an emergency (ambulance) medical care team, and 43.5% of the patients come to health care institutions by themselves. In the first day after the onset of symptoms, 63.6% of the patients call by phone to the emergency medical care service, and 21.7% of the patients apply to health care institutions by themselves in the first day of the disease. In the emergency (ambulance) medical care team visit the median time from the onset of symptoms to the request for the help was 160.5 min, in independent recourse — 477.5 min. The time from the moment of the call to the emergency medical care service to the arrival of the emergency (ambulance) medical care team to the patient’s location was investigated. The median time of the arrival to the place of the call (478 visits) was 20 min. An extremely important logistic indicator is the time from the primary medical contact to the revascularization of the myocardium. It was determined that the «door-to-needle» median indicator for the patients who had been carried out the pre-hospital thrombolysis (n=19) was 30 min, the «door-to-door» median indicator (the time from primary medical contact to hospitalization) for patients who had’t been carried out the thrombolysis (n=403) was 80 min: 1) the time «door-to-needle» in patients with acute Q-myocardial infarction was significantly lower than the «door-to-door» indicator (Dan’s criterion 4.82; p<0.01), 2) «door-to-needle» time in patients with acute coronary syndrome with elevation of the segment ST is significantly lower than the «door-to-door» indicator (Dan’s criterion 5.23; p<0.01). Conclusions. For the elderly patients, there is a significant delay in time from the first manifestation of the symptoms of the disease to the application for the medical care. Features of the clinical course of acute coronary syndrome and a significant number of atypical clinical manifestations lead to a late appeal for the medical attention, which greatly complicates the timely reperfusion.

I.M. Simak

Key words: acute coronary syndrome, acute myocardial infarction, emergency medical care, old age.

Published: 14.03.2018

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