Kirchberger Inge, Amann Ute, Heier Margit, Thilo Christian, Peters Annette, Meisinger Christa
Inge Kirchberger, PhD Senior Researcher, Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, and Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany. Ute Amann, PhD Senior Researcher, Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, and Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany. Margit Heier, MD Head, Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, and Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany. Christian Thilo, MD Senior Physician, Central Hospital of Augsburg, Department of Internal Medicine I-Cardiology, Augsburg, Germany. Annette Peters, PhD Head, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany. Christa Meisinger, MD Head, Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, and Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany.
J Cardiovasc Nurs. 2017 Jul/Aug;32(4):409-418. doi: 10.1097/JCN.0000000000000359.
Although emergency medical services (EMS) use is the recommended mode of transport in case of acute coronary symptoms, many people fail to use this service.
The objective of this study was to determine factors associated with EMS use in a population-based sample of German patients with recurrent acute myocardial infarction (AMI).
The sample consisted of 998 persons with a first and recurrent AMI, recruited from 1985 to 2011. Logistic regression modeling adjusted for sociodemographic, situational, and clinical variables, previous diseases, and presenting AMI symptoms was applied.
Emergency medical services was used by 48.8% of the patients at first, and 62.6% at recurrent AMI. In first AMI, higher age, history of hyperlipidemia, ST-segment elevation AMI, more than 4 presenting symptoms, symptom onset in daytime, and later year of AMI were significantly related with EMS use. Pain in the upper abdomen and pain between the shoulder blades were significantly less common in EMS users. In recurrent AMI, EMS use at first AMI, presence of any other symptom except chest pain, ST-segment elevation myocardial infarction, and later year of AMI were significantly related with EMS use. Significant predictors of EMS use in recurrent AMI in patients who failed to use EMS at first AMI were unmarried, experience of any symptom except chest symptoms at reinfarction, bundle branch block (first AMI), any in-hospital complication (first AMI), longer duration between first and recurrent AMI, and later year of reinfarction.
Patients with AMI and their significant others may profit by education about the benefits of EMS use.
尽管在出现急性冠状动脉症状时，推荐使用紧急医疗服务（EMS）进行转运，但许多人并未使用这项服务。
本研究的目的是确定在德国复发性急性心肌梗死（AMI）患者的基于人群的样本中，与使用EMS相关的因素。
样本包括1985年至2011年招募的998例首次发生和复发性AMI患者。应用逻辑回归模型，对社会人口统计学、情境和临床变量、既往疾病以及出现的AMI症状进行了调整。
48.8%的患者首次发生AMI时使用了紧急医疗服务，复发性AMI时这一比例为62.6%。在首次AMI中，年龄较大、有高脂血症病史、ST段抬高型AMI、出现4种以上症状、症状在白天发作以及AMI发生年份较晚与使用EMS显著相关。上腹部疼痛和肩胛骨之间疼痛在使用EMS的患者中明显较少见。在复发性AMI中，首次AMI时使用EMS、除胸痛外存在任何其他症状、ST段抬高型心肌梗死以及AMI发生年份较晚与使用EMS显著相关。在首次AMI时未使用EMS的患者中，复发性AMI时使用EMS的显著预测因素为未婚、再梗死时除胸部症状外出现任何症状、束支传导阻滞（首次AMI）、任何院内并发症（首次AMI）、首次和复发性AMI之间的持续时间较长以及再梗死年份较晚。
AMI患者及其重要他人可能会从关于使用EMS益处的教育中获益。
