Key result
Pre-hospital emergency care was associated with a higher risk of in-hospital mortality (HR 3.92) compared to other transport methods, likely reflecting its scarce use reserved for severe cases.
Why the study?
Pre-hospital emergency care has been shown to reduce in-hospital mortality in ACS, prompting an analysis of this relationship in patients treated at the UCCK ED in Kosovo.
Does pre-hospital emergency care impact in-hospital mortality in patients with acute coronary syndrome in Kosovo?
Observational (n=1,498)
No
Does pre-hospital emergency care impact in-hospital mortality in patients with acute coronary syndrome in Kosovo?
Effect estimate: HR 3.92 (95% CI 2.35-6.54)
Absolute Event Rate: 28.8% vs 7.9%
p-value: p=<0.001
In-hospital mortality for ACS remains high in Kosovo, and pre-hospital emergency care was paradoxically associated with higher mortality (HR 3.92) likely due to selection bias where only the most severe cases utilized emergency services.
Does not support deprioritizing pre-hospital emergency care in ACS; leaves open its effect after severity adjustment in prospective studies.
It has been demonstrated that pre-hospital emergency care reduces in-hospital mortality in patients admitted with acute coronary syndrome (ACS). The aim of this study was to analyze the relationship between pre-hospital emergency care and in-hospital mortality in ACS patients treated at the University Clinical Centre of Kosovo Emergency Department (UCCK ED). This observational clinical study included 1498 ACS patients treated at UCCK ED and followed-up by phone call for one year after discharge from the hospital. According to multivariate Cox regression analysis, age (HR=2.37, 95% CI 1.67-3.52), pre-hospital emergency care (HR=3.92, 95% CI 2.35-6.54), STEMI (HR=6.17, 95% CI 3.22-15.31), diabetes mellitus (HR=3.01, 95% CI 1.98-3.78), left ventricular ejection fraction <40% (HR=17.63, 95% CI 11.2-30.54) and ex-smoking (HR=2.34, 95% CI 1.57-3.85) were significant predictors of mortality in ACS patients. In-hospital mortality of patients admitted with ACS remains high in Kosovo as compared with developed countries. A better strategy for pre-hospital emergency care in Kosovo is recommended to save lives in these high-risk patients.
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Musli Gashi (2022) conducted an observational in Acute Coronary Syndrome (n=1,498). Pre-hospital emergency (PHE) care vs. Control group (other modes of transportation) was evaluated on In-hospital mortality (HR 3.92, 95% CI 2.35-6.54, p=<0.001). Pre-hospital emergency care was associated with a higher risk of in-hospital mortality (HR 3.92) compared to other transport methods, likely reflecting its scarce use reserved for severe cases.
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