The difficult medical emergency call:A register-based study of predictors and outcomes

BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as “unclear problem” in contrast to “symptom-specific” categories and the effect of categorization on mortality. METHODS: Register-based study in a 2-year period based on emergency call data from the emergency medical dispatch center in Copenhagen combined with nationwide register data. Logistic regression analysis (N = 78,040 individuals) was used for identification of predictors of emergency call categorization as “unclear problem”. Poisson regression analysis (N = 97,293 calls) was used for examining the effect of categorization as “unclear problem” on mortality. RESULTS: “Unclear problem” was the registered category in 18% of calls. Significant predictors for “unclear problem” categorization were: age (odds ratio (OR) 1.34 for age group 76+ versus 18–30 years), ethnicity (OR 1.27 for non-Danish vs. Danish), day of week (OR 0.92 for weekend vs. weekday), and time of day (OR 0.79 for night vs. day). Emergency call categorization had no effect on mortality for emergency priority level A calls, incidence rate ratio (IRR) 0.99 (95% confidence interval (CI) 0.90–1.09). For emergency priority level B calls, an association was observed, IRR 1.26 (95% CI 1.18–1.36). DISCUSSIONS: The results shed light on the complexity of emergency call handling, but also implicate a need for further improvement. Educational interventions at the dispatch centers may improve the call handling, but also the underlying supportive tools are modifiable. The higher mortality rate for patients with emergency priority level B calls with “unclear problem categorization” could imply lowering the threshold for dispatching a high level ambulance response when the call is considered unclear. On the other hand a “benefit of the doubt” approach could hinder the adequate response to other patients in need for an ambulance as there is an increasing demand and limited resources for ambulance services. CONCLUSIONS: Age, ethnicity, day of week and time of day were significant predictors of emergency call categorization as “unclear problem”. “Unclear problem” categorization was not associated with mortality for emergency priority level A calls, but a higher mortality was observed for emergency priority level B calls

Geographical clustering of incident acute myocardial infarction in Denmark:A spatial analysis approach

AbstractObjectivesTo examine the geographical patterns in AMI and characterize individual and neighborhood sociodemographic factors for persons living inside versus outside AMI clusters.MethodsThe study population comprised 3,515,670 adults out of whom 74,126 persons experienced an incident AMI (2005–2011). Kernel density estimation and global and local clustering methods were used to examine the geographical patterns in AMI. Median differences and frequency distributions of sociodemographic factors were calculated for persons living inside versus outside AMI clusters.ResultsGlobal clustering of AMI occurred in Denmark. Throughout the country, 112 significant clusters with high risk of incident AMI were identified. The relative risk of AMI in significant clusters ranged from 1.45 to 47.43 (median=4.84). Individual and neighborhood socioeconomic position was markedly lower for persons living inside versus outside AMI clusters.ConclusionsAMI is geographically unequally distributed throughout Denmark and determinants of these geographical patterns might include individual- and neighborhood-level sociodemographic factors

Association between travel distance and face-to-face consultations with general practitioners before an incident acute myocardial infarction: a nationwide register-based spatial epidemiological study

Objectives This study examined the association between travel distance to the general practitioner’s (GP) office and no face-to-face GP consultation within 1 year before an incident acute myocardial infarction (AMI).Design A prospective cohort study using multilevel spatial logistic regression analysis of nationwide register data.Setting Nationwide study including contacts to GPs in Denmark prior to an incident AMI in 2005–2017.Participants 121 232 adults (≥30 years) with incident AMI were included in the study.Primary and secondary outcomes measures The primary outcome was odds of not having a face-to-face GP consultation within 1 year before an incident AMI.Results In total, 13 108 (10.8%) of the 121 232 individuals with incident AMI had no face-to-face consultation with the GP within 1 year before the AMI. Population density modified the association between travel distance and no face-to-face GP consultation. Increased odds of no face-to-face GP consultation was observed for medium (25th–75th percentile/1123–5449 m) and long (>75th percentile/5449 m) compared with short travel distance (<25th percentile/1123 m) among individuals living in small cities (OR (95% credible intervals) of 1.19 (1.10 to 1.29) and 1.19 (1.06 to 1.33), respectively) and rural areas (1.46 (1.26 to 1.68) and 1.48 (1.29 to 1.68), respectively). No association was observed for individuals living in large cities and the capital.Conclusions Travel distance above approximately 1 km was significantly associated with no face-to-face GP consultation before an incident AMI among individuals living in small cities and rural areas. The structure of the healthcare system should consider the importance of geographical distance between citizens and the GP in remote areas

Geographical variation in a fatal outcome of acute myocardial infarction and association with contact to a general practitioner

AbstractBackgroundGeographical variation in incidence and mortality of acute myocardial infarction (AMI) is present in Denmark. We aimed at examining the association between contact to a general practitioner (GP) the year before AMI and a fatal outcome of AMI.MethodsRegister-based data and individual-level addresses including 69,608 individuals with AMI in 2006-2011. A Bayesian hierarchical logistic regression model was used to examine the association.ResultsA fatal outcome of AMI was seen among 12.0% (78%) of individuals with (without) contact to a GP the year before AMI. A significant association was estimated.ConclusionsA fatal outcome of AMI was significantly associated with contact to a GP. A high population to GP ratio and long distance to GP could not explain the increased odds of a fatal outcome of AMI for individuals with no contact to a GP

Geographical inequalities in the decreasing 28-day mortality following incident acute myocardial infarction:a Danish register-based cohort study, 1987–2016

BACKGROUND: Mortality following acute myocardial infarction (AMI) has decreased in western countries for decades; however, it remains unknown whether the decrease is distributed equally across the population independently of residential location. This study investigated whether the observed decreasing 28-day mortality following an incident AMI in Denmark from 1987 to 2016 varied geographically at municipality level after accounting for sociodemographic characteristics. METHODS: A register-based cohort study design was used to investigate 28-day mortality among individuals with an incident AMI. Global spatial autocorrelation (within sub-periods) was analysed at municipality level using Moran's I. Analysis of spatio-temporal autocorrelation before and after adjusting for sociodemographic characteristics was performed using logistic regression and conditional autoregressive models with inference in a Bayesian setting. RESULTS: In total, 368,839 individuals with incident AMI were registered between 1987 and 2016 in Denmark; 128,957 incident AMIs were fatal. The 28-day mortality decreased over time at national level with an odds ratio of 0.788 (95% credible interval (0.784, 0.792)) per 5-year period after adjusting for sociodemographic characteristics. The decrease in the 28-day mortality was geographically unequally distributed across the country and in a geographical region in northern Jutland, the 28-day mortality decreased significantly slower (4–12%) than at national level. CONCLUSIONS: During the period from 1987 to 2016, the 28-day mortality following an incident AMI decreased substantially in Denmark. However, in a local geographical region, the 28-day mortality decreased significantly slower than in the rest of the country both before and after adjusting for sociodemographic differences. Efforts should be made to keep geographical trend inequalities in the 28-day mortality to a minimum. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-022-02519-7