Factors Inflcuencing Utilization Of Pre-Emergency Medical Services In Patients With Acute Chest Pain

Objective To describe the general characteristics of patients with acute chest pain,and to analyze factors associated with patients' utilization of emergency medical services(EMS).Methods A total of 747 eligible patients with acute chest pain presenting to emergency department of Qilu hospital were consecutively enrolled from October 2014 to April 2015.Clinical information,including demographic features,mode of arrival,medical history risk factors,symptoms and signs,was collected prospectively by using standardized case report form.Univariate and multivariate analyses were conducted to investigate the association between the decision to use EMS and related factors,including demographic features,medical history risk factors,symptoms and signs.Results In the total 747 eligible patients,414 cases were male(55.4%),and the mean age was 57.2 ± 15.8y;333 cases were female(4'4.6%),and the mean age was 61.7±14.9y.171 patients used EMS,accounting for 22.9%of total patients,Cardiovascular system diseases accounted for majority of the patients with acute chest pain,which coronary heart disease played an important role,among them STEMI patients with the highest EMS,up to 50%,while the NSTEMI,SCAD,UA use EMS were less than 30%,189 cases of unexplained chest pain patients,24 patients used EMS,accounting for 12.7%.Patients under the age of 65,98 patients used EMS,accounting for 21.3%of 461 patients,65-75years age group,26 patients used EMS,accounting for 17.1%of 152 patients,more than 75 years old,47 patients used EMS,accounting for 35.1%of 134 patients.143 chest pain patients who more than 75 years old were more inclined to use EMS(P<0.001).483 cases with typical chest pain used more EMS than patients with atypical chest pain(P<0.05);356 cases with a history of hypertension or 54cases with a history of cerebral infarction were more inclined to use EMS(P<0.05 and P<0.001,respectively).Multivariate logistic regression analysis showed that male,older than 75 years,history of cerebral infarction were independent factors associated with EMS use(P<0.05).23 cases deaths patients in acute chest pain,the mortality was 3.1%,of which 17 cases of cardiovascular disease deaths,accounting for 73.9%,5cases deaths in unexplained chest pain,accounted for 21.7%.Conclusions This study indicated that only less than one-third of emergency department visits with acute chest pain decide to use EMS when symptoms occurred.Factors including male,older than 75 years,and a history of cerebral infarction were associated with more use of EMS.The primary cause of acute chest pain in patients is cardiovascular system and unexplained chest pain.these two types of patients use of EMS is low,but the mortality is high.Publicity and Education should focus on this part of the crowd to use EMS.In order to promote patient's behavior to seek EMS timely,more work need to do.