title: The impact of emergency medical services in acute heart failure.
abstract: BACKGROUND
  Real-life data on the role of emergency medical services (EMS) in acute heart failure (AHF) are scarce. Our aim was to describe prehospital treatment of AHF and to compare patients using EMS with self-presented, non-EMS patients.
  
  
  METHODS
  Data were collected retrospectively from three university hospitals in Helsinki metropolitan area between July 1, 2012 and July 31, 2013. According to the use of EMS, patients were divided into EMS and non-EMS groups.
  
  
  RESULTS
  The study included 873 AHF patients. One hundred were (11.5%) EMS and 773 (88.5%) non-EMS. EMS patients more often had comorbidities. Initial heart rate (HR) and peripheral oxygen saturation (SpO2) differed between EMS and non-EMS patients; mean HR 89.2 (SD 22.5) vs. 83.7 (21.5)/min (p=0.02) and SpO290.3 (8.6) vs. 92.9 (6.6)% (p=0.01). However, on presentation to ED EMS patients' vital signs were similar to non-EMS patients'. On presentation to ED 46.0% were normotensive and 68.2% "warm and wet". Thirty-four percentage of EMS patients received prehospital medication. In-hospital mortality was 6.0% and 7.1% (p=0.84) and length of stay (LOS) 7.7 (7.0) and 8.5 (7.9) days (p=0.36) in EMS and non-EMS groups.
  
  
  CONCLUSIONS
  The use of EMS and administration of prehospital medication was low. EMS patients had initially worse HR and SpO2than non-EMS patients. However, EMS patients' signs improved and were similar on presentation to ED. There were no differences in in-hospital mortality and LOS. This underscores the need for equal attention to any AHF patient independent of the arrival mode.
authors.affiliation: Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland, Haartmaninkatu 4, FI-00290 Helsinki, Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Harjola
authors.affiliation: Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland, Haartmaninkatu 4, FI-00290 Helsinki, Finland.
authors.forename: James
authors.initials: J
authors.lastname: Boyd
authors.affiliation: Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland, Haartmaninkatu 4, FI-00290 Helsinki, Finland.
authors.forename: Tuukka
authors.initials: T
authors.lastname: Tarvasmäki
authors.affiliation: Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland, Haartmaninkatu 4, FI-00290 Helsinki, Finland.
authors.forename: Juho
authors.initials: J
authors.lastname: Mattila
authors.affiliation: Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland, Haartmaninkatu 4, FI-00290 Helsinki, Finland.
authors.forename: Reijo
authors.initials: R
authors.lastname: Koski
authors.affiliation: Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland, Haartmaninkatu 4, FI-00290 Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Kuisma
authors.affiliation: Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland, Haartmaninkatu 4, FI-00290 Helsinki, Finland. Electronic address: veli-pekka.harjola@hus.fi.
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
mesh_terms: D000208:Acute Disease; D000368:Aged; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute heart failure; Emergency department; Emergency medical services; Prehospital management