title: Time-To-Treatment of Acute Coronary Syndrome and Unit of First Contact in the ERICO Study.
abstract: BACKGROUND
  To the best of our knowledge, there are no studies evaluating the influence of the unit of the first contact on the frequency and time of pharmacological treatment during an acute coronary syndrome (ACS) event.
  
  
  OBJECTIVE
  The main objective was to investigate if the unit of first contact influenced the frequency and time of aspirin treatment in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study.
  
  
  METHODS
  We analyzed the pharmacological treatment time in 830 ERICO participants - 700 individuals for whom the hospital was the unit of first contact and 130 who initially sought primary care units. We built logistic regression models to study whether the unit of first contact was associated with a treatment time of less than three hours.
  
  
  RESULTS
  Individuals who went to primary care units received the first aspirin dose in those units in 75.6% of the cases. The remaining 24.4% received aspirin at the hospital. Despite this finding, individuals from primary care still had aspirin administered within three hours more frequently than those who went to the hospital (76.8% vs 52.6%; p<0.001 and 100% vs. 70.7%; p=0.001 for non ST-elevation ACS and ST-elevation myocardial infarction, respectively). In adjusted models, individuals coming from primary care were more likely to receive aspirin more quickly (odds ratio: 3.66; 95% confidence interval: 2.06-6.51).
  
  
  CONCLUSIONS
  In our setting, individuals from primary care were more likely to receive aspirin earlier. Enhancing the ability of primary care units to provide early treatment and safe transportation may be beneficial in similar settings.
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Rafael Caire de Oliveira Dos
authors.initials: RC
authors.lastname: Santos
authors.affiliation: Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Alessandra Carvalho
authors.initials: AC
authors.lastname: Goulart
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Alan Loureiro Xavier
authors.initials: AL
authors.lastname: Kisukuri
authors.affiliation: Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Rodrigo Martins
authors.initials: RM
authors.lastname: Brandão
authors.affiliation: Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Debora
authors.initials: D
authors.lastname: Sitnik
authors.affiliation: Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Henrique Lane
authors.initials: HL
authors.lastname: Staniak
authors.affiliation: Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Marcio Sommer
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Paulo Andrade
authors.initials: PA
authors.lastname: Lotufo
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Isabela Martins
authors.initials: IM
authors.lastname: Bensenor
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Itamar de Souza
authors.initials: IS
authors.lastname: Santos
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage*; D001938:Brazil; D000077144:Clopidogrel; D004522:Educational Status; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin