Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes

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dc.contributor.advisorWallis, Lee Aen_ZA
dc.contributor.authorCallachan, Edwarden_ZA
dc.date.accessioned2017-09-14T12:14:54Z
dc.date.available2017-09-14T12:14:54Z
dc.date.issued2017en_ZA
dc.description.abstractIntroduction: Acute coronary syndromes, including ST-elevation myocardial infarction (STEMI), are a leading cause of morbidity and mortality worldwide. Existing research shows that prehospital care provided by emergency medical services (EMS) can significantly improve outcomes. However, EMS remains grossly underutilised in Abu Dhabi despite a well-established presence. Objectives: In this three-part quantitative, observational study, we sought to (1) assess physicians' perceptions of, and recommendations for, utilization and improvement of EMS, (2) assess patients' awareness of EMS, mode of transport use in decision to seek care and reasons for their decision, and (3) establish if in the current study setting, mode of transport used has implications for in hospital adverse events, as well as short and long term clinical outcomes. The goal was to investigate both physicians' and patients' perceptions of prehospital STEMI care, as well as to assess the clinical correlates of the mode of transport in a patient's decision to seek care. Methods: We conducted the study in three phases. Phase 1: At four government-operated hospitals in Abu Dhabi, we administered surveys to a convenience sample of physicians involved in care of patients with acute coronary syndromes to measure (a) likelihood of recommending EMS, (b) satisfaction with EMS, (c) likelihood of using EMS for self or family, and (d) recommendations for prehospital care of acute coronary syndromes. Phase 2: We gathered mode of transport data from a purposive, non-random sample of 587 consecutive patients with STEMI over an 18-month period and conducted structured follow-up interviews to assess their perceptions of EMS. We conducted analysis to determine whether mode of transport was related to demographic variables. Phase 3: We collected medical records from patient participants and conducted structured follow-up interviews at 1, 6 and 12 months post discharge. We conducted chi square difference testing to determine the relationships among mode of transport, treatment times, and short- and long-term clinical outcomes. Variables included treatment times and associated outcomes. Results: Physician participants (n = 106) were most supportive of prehospital 12-lead ECG for STEMI, but indicated low satisfaction with existing EMS services in Abu Dhabi. Among STEMI patient participants (n = 587), EMS was underutilized in Abu Dhabi; over half (55%) of patients did not know the phone number to contact EMS, and only 14.7% used EMS in their decision to seek care. EMS-transported patients were more likely to receive timely treatment (door-todiagnostic ECG time, door-to-balloon time) and had lower incidence of mortality compared to privately-transported patients. Conclusions: These findings suggest a need to raise public awareness of EMS and its importance for coronary symptoms in Abu Dhabi. Broader application of prehospital ECG, including prehospital activation of cardiac catheterization labs, bypassing non-interventional cardiology centres, and admission directly to facilities that provide these services without initial admission to the emergency department, could help improve physicians' perceptions of EMS and outcomes for patients with STEMI.en_ZA
dc.identifier.apacitationCallachan, E. (2017). <i>Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine. Retrieved from http://hdl.handle.net/11427/25168en_ZA
dc.identifier.chicagocitationCallachan, Edward. <i>"Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine, 2017. http://hdl.handle.net/11427/25168en_ZA
dc.identifier.citationCallachan, E. 2017. Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Callachan, Edward AB - Introduction: Acute coronary syndromes, including ST-elevation myocardial infarction (STEMI), are a leading cause of morbidity and mortality worldwide. Existing research shows that prehospital care provided by emergency medical services (EMS) can significantly improve outcomes. However, EMS remains grossly underutilised in Abu Dhabi despite a well-established presence. Objectives: In this three-part quantitative, observational study, we sought to (1) assess physicians' perceptions of, and recommendations for, utilization and improvement of EMS, (2) assess patients' awareness of EMS, mode of transport use in decision to seek care and reasons for their decision, and (3) establish if in the current study setting, mode of transport used has implications for in hospital adverse events, as well as short and long term clinical outcomes. The goal was to investigate both physicians' and patients' perceptions of prehospital STEMI care, as well as to assess the clinical correlates of the mode of transport in a patient's decision to seek care. Methods: We conducted the study in three phases. Phase 1: At four government-operated hospitals in Abu Dhabi, we administered surveys to a convenience sample of physicians involved in care of patients with acute coronary syndromes to measure (a) likelihood of recommending EMS, (b) satisfaction with EMS, (c) likelihood of using EMS for self or family, and (d) recommendations for prehospital care of acute coronary syndromes. Phase 2: We gathered mode of transport data from a purposive, non-random sample of 587 consecutive patients with STEMI over an 18-month period and conducted structured follow-up interviews to assess their perceptions of EMS. We conducted analysis to determine whether mode of transport was related to demographic variables. Phase 3: We collected medical records from patient participants and conducted structured follow-up interviews at 1, 6 and 12 months post discharge. We conducted chi square difference testing to determine the relationships among mode of transport, treatment times, and short- and long-term clinical outcomes. Variables included treatment times and associated outcomes. Results: Physician participants (n = 106) were most supportive of prehospital 12-lead ECG for STEMI, but indicated low satisfaction with existing EMS services in Abu Dhabi. Among STEMI patient participants (n = 587), EMS was underutilized in Abu Dhabi; over half (55%) of patients did not know the phone number to contact EMS, and only 14.7% used EMS in their decision to seek care. EMS-transported patients were more likely to receive timely treatment (door-todiagnostic ECG time, door-to-balloon time) and had lower incidence of mortality compared to privately-transported patients. Conclusions: These findings suggest a need to raise public awareness of EMS and its importance for coronary symptoms in Abu Dhabi. Broader application of prehospital ECG, including prehospital activation of cardiac catheterization labs, bypassing non-interventional cardiology centres, and admission directly to facilities that provide these services without initial admission to the emergency department, could help improve physicians' perceptions of EMS and outcomes for patients with STEMI. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes TI - Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes UR - http://hdl.handle.net/11427/25168 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/25168
dc.identifier.vancouvercitationCallachan E. Mode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomes. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/25168en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Emergency Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherEmergency Medicineen_ZA
dc.titleMode of transport to hospital among patients with ST Elevation Acute Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi: correlates, physician and patient attitudes, and associated clinical outcomesen_ZA
dc.typeDoctoral Thesis
dc.type.qualificationlevelDoctoral
dc.type.qualificationnamePhDen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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