Dimens Crit Care Nurs. 2023;42(2):95-103. doi: 10.1097/DCC.0000000000000566.
Patients with acute coronary syndrome (ACS) with symptoms matching their expectations of a heart attack are more likely to use emergency medical services (EMS) than not.
To determine whether presenting symptom clusters are associated with EMS use in ACS patients and if EMS use or symptom clusters are associated with prehospital delay.
This secondary analysis used data from the PROMOTION trial, a randomized clinical trial that enrolled 3522 subjects with a history of or at risk for ACS from 5 sites in the United States, Australia, and New Zealand. Subjects were randomized to usual care or an educational intervention to reduce prehospital delay. During the 2-year follow-up, subjects admitted for ACS were asked about symptoms, time of symptom onset, and mode of transportation to the hospital. Symptoms were grouped into classic ACS, pain symptoms, and stress symptoms clusters.
Of 3522 subjects enrolled, 331 sought care for ACS during follow-up; 278 had transportation mode documented; 121 (44%) arrived via EMS. Classic ACS plus pain symptoms (adjusted odds ratio [AOR], 2.66; P = .011), classic ACS plus stress symptoms (AOR, 2.61; P = .007), and classic ACS plus both pain and stress symptoms (AOR, 3.90; P = .012) were associated with higher odds of EMS use versus classic ACS symptoms alone. Emergency medical services use resulted in a 68.5-minute shorter median delay (P = .002) versus non-EMS use. Symptom clusters were not predictive of delay time in the adjusted model (P = .952).
Although chest symptoms were the most prevalent symptoms for most (85%), the combination of classic ACS symptoms with other symptom clusters was associated with higher EMS use. Further research is needed to determine whether a combination of symptom clusters helps patients correctly interpret ACS symptoms to better understand how symptom clusters influence EMS use.
出现与自己预期的心脏病发作症状相符的急性冠脉综合征（ACS）的患者更有可能使用紧急医疗服务（EMS）。
确定ACS 患者的症状群是否与 EMS 使用相关，以及 EMS 使用或症状群是否与院前延迟相关。
本二次分析使用了来自 PROMOTION 试验的数据，该试验是一项在美国、澳大利亚和新西兰的 5 个地点进行的、纳入了有或有 ACS 风险史的 3522 例患者的随机临床试验。患者被随机分配至常规护理或教育干预以减少院前延迟。在 2 年的随访期间，因 ACS 入院的患者被询问症状、症状发作时间和到医院的交通方式。症状被分为经典 ACS、疼痛症状和应激症状群。
在纳入的 3522 例患者中，有 331 例在随访期间因 ACS 寻求治疗；有 278 例记录了交通方式；121 例（44%）通过 EMS 到达。经典 ACS 加疼痛症状（调整后的优势比 [AOR]，2.66；P =.011）、经典 ACS 加应激症状（AOR，2.61；P =.007）和经典 ACS 加疼痛和应激症状（AOR，3.90；P =.012）与 EMS 使用的可能性高于经典 ACS 症状单独出现的可能性更高。与非 EMS 使用相比，EMS 使用导致中位数延迟时间缩短了 68.5 分钟（P =.002）。在调整后的模型中，症状群与延迟时间无关（P =.952）。
尽管胸痛是大多数（85%）患者最常见的症状，但经典 ACS 症状与其他症状群的组合与更高的 EMS 使用相关。需要进一步研究以确定症状群的组合是否有助于患者正确解释 ACS 症状，以更好地了解症状群如何影响 EMS 使用。
