Key result
A final diagnosis of acute myocardial infarction was associated with a higher likelihood of receiving prehospital acetylsalicylic acid (OR 2.94), though overall adherence in AMI patients was only 50%.
Why the study?
Emergency medical services guidelines aim to promote best practice, but adherence among prehospital emergency nurses caring for chest pain patients had not been described.
Cohort (n=2,092)
No
Answers are grounded in this paper and cite their sources.
Prehospital guideline adherence for chest pain is high for examinations but defective for pharmaceutical treatments, with women and those without a final AMI diagnosis being significantly less likely to receive indicated medications like acetylsalicylic acid.
BACKGROUND: The emergency medical services (EMS) use guidelines to describe optimal patient care for a wide range of clinical conditions and symptoms. The intent is to guide personnel to provide patient care in line with best practice. The aim of this study is to describe adherence to such guidelines among prehospital emergency nurses (PENs) when caring for patients with chest pain. OBJECTIVE: To describe guideline adherence among PENs when caring for patients with chest pain. To investigate whether guideline adherence is associated with patient age, sex or final diagnosis of acute myocardial infarction on hospital discharge. METHODS: Guideline adherence in terms of patient examination and pharmaceutical treatment was analysed in a cohort of 2092 EMS missions carried out in 2018 in Region Halland, Sweden. Multivariate regression was used to describe how guideline adherence is associated with patient age, sex and diagnosis on hospital discharge. RESULTS: Guideline adherence was high regarding examination of vital signs (93%) and electrocardiogram (ECG) registration (96%) but lower in terms of pharmaceutical treatment (ranging from 28 to 90%). Adherence was increased in cases in which the patient ended up with acute myocardial infarction (AMI) as diagnosis on discharge. Patients with AMI were given acetylsalicylic acid by PENs in 50% of cases. Women were less likely than men to receive treatment with acetylsalicylic acid and oxycodone. CONCLUSIONS: Guideline adherence among PENs when caring for patients with chest pain is satisfactory in terms vital signs and ECG registration. Regarding pharmaceutical treatment guideline adherence is defective. Improved adherence is mainly associated with male sex in patients and a diagnosis of AMI on hospital discharge. Defective adherence excludes measures known to improve patients' prognoses such as treatment with acetylsalicylic acid.
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Wibring et al. (2021) conducted a cohort in Chest pain (n=2,092). Acute myocardial infarction (AMI) diagnosis on hospital discharge vs. No AMI diagnosis was evaluated on Guideline adherence for acetylsalicylic acid administration (OR 2.94, 95% CI 2.24-3.86, p=<0.001). A final diagnosis of acute myocardial infarction was associated with a higher likelihood of receiving prehospital acetylsalicylic acid (OR 2.94), though overall adherence in AMI patients was only 50%.
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