Harjola Pia, Boyd James, Tarvasmäki Tuukka, Mattila Juho, Koski Reijo, Kuisma Markku, Harjola Veli-Pekka
Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland, Haartmaninkatu 4, FI-00290 Helsinki, Finland.
Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland, Haartmaninkatu 4, FI-00290 Helsinki, Finland.
Int J Cardiol. 2017 Apr 1;232:222-226. doi: 10.1016/j.ijcard.2017.01.017. Epub 2017 Jan 4.
Real-life data on the role of emergency medical services (EMS) in acute heart failure (AHF) are scarce. Our aim was to describe prehospital treatment of AHF and to compare patients using EMS with self-presented, non-EMS patients.
Data were collected retrospectively from three university hospitals in Helsinki metropolitan area between July 1, 2012 and July 31, 2013. According to the use of EMS, patients were divided into EMS and non-EMS groups.
The study included 873 AHF patients. One hundred were (11.5%) EMS and 773 (88.5%) non-EMS. EMS patients more often had comorbidities. Initial heart rate (HR) and peripheral oxygen saturation (SpO) differed between EMS and non-EMS patients; mean HR 89.2 (SD 22.5) vs. 83.7 (21.5)/min (p=0.02) and SpO 90.3 (8.6) vs. 92.9 (6.6)% (p=0.01). However, on presentation to ED EMS patients' vital signs were similar to non-EMS patients'. On presentation to ED 46.0% were normotensive and 68.2% "warm and wet". Thirty-four percentage of EMS patients received prehospital medication. In-hospital mortality was 6.0% and 7.1% (p=0.84) and length of stay (LOS) 7.7 (7.0) and 8.5 (7.9) days (p=0.36) in EMS and non-EMS groups.
The use of EMS and administration of prehospital medication was low. EMS patients had initially worse HR and SpO than non-EMS patients. However, EMS patients' signs improved and were similar on presentation to ED. There were no differences in in-hospital mortality and LOS. This underscores the need for equal attention to any AHF patient independent of the arrival mode.
关于紧急医疗服务（EMS）在急性心力衰竭（AHF）中作用的实际数据稀缺。我们的目的是描述AHF的院前治疗情况，并比较使用EMS的患者与自行就诊的非EMS患者。
回顾性收集2012年7月1日至2013年7月31日期间赫尔辛基大都会区三家大学医院的数据。根据是否使用EMS，将患者分为EMS组和非EMS组。
该研究纳入了873例AHF患者。其中100例（11.5%）使用EMS，773例（88.5%）为非EMS患者。EMS患者合并症更多见。EMS组和非EMS组患者的初始心率（HR）和外周血氧饱和度（SpO）存在差异；平均HR分别为89.2（标准差22.5）次/分钟和83.7（21.5）次/分钟（p = 0.02），SpO分别为90.3（8.6）%和92.9（6.6）%（p = 0.01）。然而，在到达急诊科时，EMS患者的生命体征与非EMS患者相似。到达急诊科时，46.0%的患者血压正常，68.2%的患者“暖湿”。34%的EMS患者接受了院前用药。EMS组和非EMS组的住院死亡率分别为6.0%和7.1%（p = 0.84），住院时间（LOS）分别为7.7（7.0）天和8.5（7.9）天（p = 0.36）。
EMS的使用和院前用药的比例较低。EMS患者初始时的HR和SpO比非EMS患者差，但EMS患者的体征在到达急诊科时有所改善且相似。住院死亡率和住院时间无差异。这强调了对任何AHF患者无论其到达方式如何都应给予同等关注的必要性。
