A nurse-led pre-hospital triage service for identifying patients with occlusive myocardial infarction: a service evaluation: a service evaluation

Charles Knoery, Charlie Bloe, Aleeha Iftikhar, RR Bond, Matthew Manktelow, V. E. McGilligan, Khaled Rjoob, Aaron Peace, Anne McShane, Janet Heaton, Stephen James Leslie

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Aims:
Acute coronary syndromes include unstable angina and myocardial infarction, of which occlusive myocardial infarction is a high-risk subset that is often missed because of lack of ST elevation. Pre-hospital electrocardiograms may be able to identify myocardial infarction early and reduce mortality. However, it is unclear whether pre-hospital electrocardiograms can accurately detect occlusive myocardial infarction and how this effects outcomes. This study will analyse the outcomes of patients with occlusive myocardial infarction who had a pre-hospital electrocardiogram.
Method:
Electrocardiograms transmitted to the coronary care unit triage service were identified, along with data regarding patient demographics, referrals and mortality. Data were analysed for correlations between demographic and clinical factors and type of myocardial infarction.
Results:
A total of 838 electrocardiograms were identified; 69 (8.2%) showed myocardial infarction and eight (1.0%) showed occlusive myocardial infarction, of which 50% had ST elevation. Patients with occlusive myocardial infarction were more likely to be triaged to the coronary care unit than patients with non-occlusive myocardial infarction (P=0.04). However, 38 (55.1%) patients with myocardial infarction and four (50.0%) patients with occlusive myocardial infarction were not directed to a coronary care unit or the catheterization laboratory. Patients with occlusive myocardial infarction had higher index episode mortality rates (P=0.03) and 30-day mortality rates (P<0.01).
Conclusions:
Despite pre-hospital electrocardiogram transmission and adherence to the guidelines, triage of myocardial infarction and occlusive myocardial infarction is imperfect. Refinement of risk scores such and adaptation of new technology is required to help identify patients with occlusive myocardial infarction so they can be prioritised for immediate reperfusion therapy.
Original languageEnglish
JournalBritish Journal of Cardiac Nursing
Early online date26 Apr 2022
DOIs
Publication statusE-pub ahead of print - 26 Apr 2022

Bibliographical note

This project was supported by the European Union’s INTERREG VA Programme, managed by the
Special EU Programmes Body. The funders of this project had no input in the design,
implementation or writing of this study.

Keywords

  • acute myocardial infarction
  • occlusive myocardial infarction
  • STEMI
  • ECG

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