DOI: 10.1161/jaha.125.048335 ISSN: 2047-9980

Emergency Medical Service Identification and Prehospital Care of Acute Coronary Syndrome Among Culturally and Linguistically Diverse Immigrants: Statewide Linkage Study

Ararso Baru Olani, Stuart Howell, Kathryn Eastwood, Ziad Nehme, Emily Mahony, Emily Nehme, Dion Stub, Janet E. Bray
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Background

Timely recognition and response to acute coronary syndrome (ACS) by emergency medical services is critical to reducing delays and improving outcomes. This study examines whether emergency medical services identification, care, and times (the interval from emergency medical services call to hospital arrival) differ by culturally and linguistically diverse (CALD) background among patients with ACS.

Methods

We conducted a retrospective cohort study using ambulance data linked with the Department of Health's hospital data sets (January 2015–June 2019). The CALD group comprised individuals born in non–English‐speaking countries or who preferred to speak a language other than English (LOTE). Based on preferred language, the CALD group was stratified as CALD‐LOTE versus CALD‐English.

Results

Of the 28 557 ACS cases, 30.2% were CALD immigrants: 9.5% CALD‐LOTE and 20.7% CALD‐English. Chest pain was the most common chief complaint (69.1%) but was lowest among CALD‐LOTE patients (59.4%) (CALD‐English=68.6%, Australian born=70.8%). Time‐critical ambulance dispatch (lights and sirens) was not statistically different across groups, but paramedic ACS identification was lower in CALD‐LOTE than in Australian‐born patients (57.2% versus 69.0%; adjusted odds ratio=0.84 [95% CI, 0.76–0.92]). CALD‐LOTE and CALD‐English patients had higher rates of direct transfer to percutaneous coronary intervention–capable hospitals compared with Australian‐born patients with ACS. Emergency medical services times were not statistically different in metropolitan areas but were marginally longer in rural areas among CALD patients than among non‐CALD patients (67.5 versus 63.7 minutes; P =0.02).

Conclusions

Despite lower ACS identification by paramedics, CALD‐LOTE patients were more often transported to percutaneous coronary intervention–capable hospitals. Given the implications of missed early identification of ACS for outcomes, further research is needed to understand this variation and to inform tailored strategies for improvement.

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