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Byline: Linda Becker, Mary Pat Larsen, Mickey S Eisenberg Abstract: Study objective: To assess the incidence of cardiac arrest among patients who use self-transport to seek medical care for chest pain. Methods: This was a retrospective cohort study of patients admitted to a CCU for suspected acute myocardial infarction (AMI) and patients experiencing out-of-hospital cardiac arrest preceded by symptoms in King County, Washington, between January 1, 1992, and July 31, 1994. Participants were identified through use of the databases compiled by the Myocardial Infarction Triage and Intervention Trial, which reviewed medical records in all area hospitals, and the Cardiac Arrest Surveillance System, which tracks all incidences in which CPR is performed by EMS personnel in King County. Patients whose sudden cardiac arrests were not preceded by symptoms were excluded. Hospital records were abstracted to find the means of transport for patients admitted to CCUs. For cardiac arrest patients, the medical history, presence of symptoms, means of transport, and prehospital death information were abstracted from paramedic field reports. Outcome (admission, discharge, or in-hospital death) was obtained from hospital records. An event cause (cardiac or other) was determined from death certificates, hospital records, or consultation with private physicians. Results: During the 30-month study period, 13,187 patients sought help for cardiac symptoms and were either admitted to a CCU or died before admission after calling 911. A majority, 7,393 (59%), were transported by emergency medical services, and 5,182 (41%) used private transportation to obtain medical care; the means of transport could not be determined for 612 patients. Of the EMS group, 6,978 were admitted to the hospital without experiencing prehospital cardiac arrest, and 415 (5.6%) arrested before arriving at the hospital. Of the group using private transportation, 5,164 were admitted without arresting and 18 (.35%) arrested before arrival, after which 911 was called (P Article History: Received 20 November 1995; Revised 10 April 1996; Revised 15 July 1996; Accepted 25 July 1996 Article Note: (footnote) [star] From the King County Emergency Medical Services Division*, and the Center for Evaluation of Emergency Medical Servicesa Seattle-King County Department of Public Health; and the Department of Medicine, University of WashingtonAs., Seattle, Washington., [star][star] Address for reprints: Linda Becker, MA, King County Emergency Medical Services Division, Seattle-King County Department of Public Health, 900 Fourth Avenue, Suite 850, Seattle, Washington 98164, a Reprint no. 47/1/77733

The attempt to resuscitate persons with sudden and unexpected death is as old as recorded history. Written descriptions of resuscitations are found in the Hebrew Bible. Through the centuries, physicians […]

Byline: Hendrika Meischke, Mary T Ho, Mickey S Eisenberg, Sharon M Schaeffer, Mary P Larsen Abstract: Study objective: To determine the reasons patients with suspected acute myocardial infarction (AMI) delay seeking medical care or do not call 911. Design: Telephone interview of patients hospitalized with suspected AMI. Setting: Nine hospitals in King County, Washington. Participants: Patients admitted to a CCU or ICU between October 1, 1986, and December 31, 1987, with suspected AMI occurring out-of-hospital. Spouses of patients who met criteria but died during the hospitalization also participated. Interventions: Hospital records were reviewed, and a 20-minute telephone interview was conducted of patients who reside in King County but do not live in an extended care facility. Measurements: Patient demographics, cardiac history, symptoms, time of acute symptom onset, time of emergency department arrival, method of transportation, discharge diagnosis, and hospital outcome were abstracted from hospital records. Circumstances leading to the hospitalization, reasons for delay in seeking care, and reasons for not calling 911 were determined in the telephone interview. Results: In a 15-month period, 5,207 patients were hospitalized for suspected AMI in King County, Washington. Twenty-seven percent had AMI. Median patient delay between symptom onset and hospital arrival was 2 hours. Paramedics transported 45% of all patients. A representative subset of patients (2,316) were interviewed. The main reasons for delay were because the patient thought that the symptoms would go away, because the symptoms were not severe enough, and because the patient thought that the symptoms were caused by another illness. The main reasons for not calling 911 were because the symptoms were not severe enough, because the patient did not think of calling 911, and because the patient thought that self-transport would be faster because of his or her close location to the hospital. Conclusion: Maximal benefit from thrombolytic therapy is not realized in a substantial proportion of patients with AMI because of delays in seeking medical care. Knowledge of the reasons patients delay or do not call 911 can help focus efforts on achieving more rapid treatment of patients with AMI. [Meischke H, Ho MT, Eisenberg MS, Schaeffer SM, Larsen MP: Reasons patients with chest pain delay or do not call 911. Ann Emerg Med February 1995;25:193-197.] Article History: Received 11 July 1994; Accepted 15 August 1994 Article Note: (footnote) [star] From the Department of Health Services, School of Public Health and Community Medicine, University of Washington*; the Center for Evaluation of Emergency Medical Services, Emergency Medical Services Division, Seattle-King County, Department of Public Healtha ; and the Department of Medicine, University of WashingtonAs., Seattle., [star][star] Support for this study was provided in part by a grant from Genentech, Inc, San Francisco, California., a Address for reprints: Hendrika Meischke, PhD, Center for Evaluation of Emergency Medical Services, Emergency Medical Services Division, Seattle-King County Department of Public Health, 900 Fourth Avenue, Suite 850, Seattle, Washington 98164, aa Reprint no. 47/1/61923

This study was conducted in 19 hospitals in the metropolitan Seattle area and included 6,270 unselected patients who had acute myocardial infarction (AMI) between January 1988 and April 1991. Hospital mortality was determined and related to patient demographic and clinical characteristics, the use of reperfusion therapies, and to complications after AMI. Thrombolytic therapy or direct coronary angioplasty

Background: Studies of elderly patients who have out-of-hospital cardiac arrest have contradictory results. The studies usually define elderly patients as those older than 70 years, and include relatively few octogenarians and nonagenarians. Objectives: To compare the survival after out-of-hospital cardiac arrest of octogenarians, nonagenarians, and younger patients and to determine the influence of age on survival after adjusting for factors known to influence out-of-hospital cardiac arrest outcome. Methods: We conducted a retrospective cohort study in suburban King County, Washington, on 5882 patients who had out-of-hospital cardiac arrest from presumed cardiovascular disease between January 1, 1987, and December 31, 1998, and who received cardiopulmonary resuscitation from bystanders, emergency medical technicians, or both. The main outcome measure was survival to hospital discharge. Results: In patients who had out-of-hospital cardiac arrest due to a cardiac cause, younger patients had higher hospital discharge rates than octogenarians, who in turn had higher hospital discharge rates than nonagenarians (19.4% vs 9.4% vs 4.4%; P [is less than] .001). However, survival to hospital discharge improved significantly for younger patients, octogenarians, and nonagenarians who had ventricular fibrillation or pulseless ventricular tachycardia (36% vs 24% vs 17%; P [is less than] .001). After multiple logistic regression analysis controlling for other factors, increased age was weakly associated with decreased survival to hospital discharge (odds ratio, 0.92; 95% confidence interval, 0.85-0.99). Conclusions: Octogenarians and nonagenarians have lower survival to hospital discharge than younger patients, but age is a much weaker predictor of survival than other factors such as initial cardiac rhythm. Decisions regarding resuscitation should not be based on age alone. Arch Intern Med. 2000;160:3439-3443