Characteristics of Patients with Chest Pain Arriving by Ambulance vs Private Transport

• Published in: Academic emergency medicine 2003-05, Vol.10 (5), p.451-452
• Main Author: Christenson, J. M
• Format: Article
• Language: English
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1197/aemj.10.5.451-b

OBJECTIVES: Approximately 50% of patients with a final diagnosis of AMI arrive to emergency departments by ambulance. Regional policies for the care of ACS often focus on patients transported by ambulance. We hypothesized that patients with chest pain arriving by ambulance are demographically distinct and more likely to have acute coronary syndrome (ACS). METHODS: We compared patients enrolled in a prospective cohort study of 1819 patients presenting with chest pain who arrived by ambulance (AMB) or not (nonAMB). Subjects were consecutive consenting patients >25 years old, living in British Columbia with complete follow-up at 30-days. Explicitly defined diagnoses were applied for categories of ACS: AMI, definite unstable angina (UA), possible UA, no ACS with an adverse event (AE) and no ACS/AE. We compared presenting demographics, risk factors, diagnostic outcomes and mortality. Differences with 95% confidence intervals were calculated. RESULTS: 564 (31%) of patients arrived by ambulance. The AMB and nonAMB groups were 64.6 vs 55.4 years old (95% CI of difference; 7.7,10.8), were 52% vs 61% male (95% CI of difference; -14, -4%), took a median time of 100 min vs 135 min from symptom onset to ED arrival (95% CI of difference; -42, -6), had an incidence of 54% vs 35% of past AMI or angina (95% CI of difference; 14,23), had a 19% (106/564) vs 11% (135/1255) final outcome of AMI (95% CI of difference; 4,12) and a 8% (43/564) vs 9% (114/1255) incidence of no unstable angina (95% CI of difference; -4,1). CONCLUSIONS: Patients with chest pain who arrive by ambulance are different from those not using ambulance services. They are older, less likely to be male, have shorter duration of symptoms, more likely to have previous coronary disease and more likely to have ACS. However, just as many patients with ACS arrive by private means, highlighting the need for regional carepaths to include strategies for patients who do not arrive by ambulance.