title: Frequency and consequences of recording an electrocardiogram >10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE Initiative).
abstract: We sought to determine the frequency of electrocardiographic (ECG) acquisition within 10 minutes of hospital arrival, factors associated with delayed ECG acquisition, and any relation among delayed ECG acquisition, treatment patterns, and clinical outcomes. We therefore analyzed data from 63,478 patients (26,615 women, 42%) with high-risk non-ST-segment elevation acute coronary syndromes (designated by positive cardiac markers and/or ischemic ST-segment changes) who were enrolled in the CRUSADE Quality Improvement Initiative from February 2001 to March 2004. Patients were categorized based on time to electrocardiography as delayed (>10 minutes from hospital arrival) or nondelayed (<10 minutes). Multivariable predictors of delayed ECG acquisition were determined. Overall, median time to electrocardiography was 15 minutes (25th to 75th percentile 7 to 32). ECG acquisition was delayed (median 25 minutes, 25th to 75th percentile 16 to 50) in 41,397 patients (65.2%). In the remaining 34.8%, time to electrocardiography was <10 minutes (median 5 minutes, 25th to 75th percentile 3 to 8). Women were more likely than men to have delayed ECG acquisition (69% vs 62%), and female gender was the most significant predictor of delayed ECG acquisition (odds ratio 1.29, 95% confidence interval 1.25 to 1.34). In conclusion, only 33% of high-risk patients with non-ST-segment elevation acute coronary syndrome had an initial electrocardiogram obtained <10 minutes of arrival as recommended. Women were significantly more likely than men to have delayed ECG acquisition. Emergency departments should focus on decreasing the time to initial ECG acquisition to improve treatment of acute coronary syndrome in this group.
authors.affiliation: University of California Davis Medical Center, Sacramento, California, USA. dbdiercks@ucdavis.edu
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Brian C
authors.initials: BC
authors.lastname: Hiestand
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Chen
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Kirk
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.forename: W Brian
authors.initials: WB
authors.lastname: Gibler
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Andra L
authors.initials: AL
authors.lastname: Blomkalns
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D013997:Time Factors; D016896:Treatment Outcome