title: First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study.
abstract: OBJECTIVE
  It is unknown into what extent patients with ST-elevation myocardial infarction (STEMI) utilise a joint service number (Swedish Healthcare Direct, SHD) as first medical contact (FMC) instead of Emergency Medical Services (EMS) and how this impact time to diagnosis. We aimed to (1) describe patients' FMC; (2) find explanatory factors influencing their FMC (ie, EMS and SHD) and (3) explore the time interval from symptom onset to diagnosis.
  
  
  METHODS
  Multicentred study, Sweden.
  
  
  METHODS
  Cross-sectional, enrolling patients with consecutive STEMI admitted within 24 h from admission.
  
  
  RESULTS
  We included 109 women and 336 men (mean age 66±11 years). Although 83% arrived by ambulance to the hospital, just half of the patients (51%) called EMS as their FMC. Other utilised SHD (21%), contacted their primary healthcare centre (14%), or went directly to the emergency room (14%). Reasons for not contacting EMS were predominantly; (1) my transport mode was faster (40%), (2) did not consider myself sick enough (30%), and (3) it was easier to be driven or taking a taxi (25%). Predictors associated with contacting SHD as FMC were female gender (OR 1.92), higher education (OR 2.40), history of diabetes (OR 2.10), pain in throat/neck (OR 2.24) and pain intensity (OR 0.85). Predictors associated with contacting EMS as FMC were history of MI (OR 2.18), atrial fibrillation (OR 3.81), abdominal pain (OR 0.35) and believing the symptoms originating from the heart (OR 1.60). Symptom onset to diagnosis time was significantly longer when turning to the SHD instead of the EMS as FMC (1:59 vs 1:21 h, p<0.001).
  
  
  CONCLUSIONS
  Using other forms of contacts than EMS, significantly prolong delay times, and could adversely affect patient prognosis. Nevertheless, having the opportunity to call the SHD might also, in some instances, lower the threshold for taking contact with the healthcare system, and thus lowers the number that would otherwise have delayed even longer.
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Ingela
authors.initials: I
authors.lastname: Thylén
authors.affiliation: Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Ericsson
authors.affiliation: Department of Cardiology, Heart Centre and Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Hellström Ängerud
authors.affiliation: Department of Research, Norrbotten County Council, Luleå, Sweden Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Rose-Marie
authors.initials: RM
authors.lastname: Isaksson
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Sederholm Lawesson
mesh_terms: D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data*; D001281:Atrial Fibrillation / Q000453:epidemiology; D001294:Attitude to Health; D002637:Chest Pain; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology; D004522:Educational Status; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D015277:Hotlines / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D010147:Pain Measurement; D012720:Severity of Illness Index; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors