Authors:

P Harjola¹ , VP Harjola¹ , M Kuisma¹ , M Christ² , X Escalada³ , F Martin-Sanchez⁴ , O Miro⁵ , ¹Helsinki University Hospital, Emergency Care - Helsinki - Finland , ²Luzern Hospital, Emergency department - Luzern - Switzerland , ³Hospital Clinic de Barcelona, Sistema d'Emergències Mèdiques, Catalunya - Barcelona - Spain , ⁴Hospital Clinic San Carlos, Emergency department - Madrid - Spain , ⁵Hospital Clinic de Barcelona, Emergency department - Barcelona - Spain ,

Background: Acute heart failure (AHF) is one of the most important causes for hospital admission. The prehospital treatment of AHF is a novel topic in the recent literature. Real-life data about the readiness of dispatch centres and emergency medical services (EMS) to treat and diagnose AHF is scarce.

Purpose: Our main interest was to find out the difficulty of EMS and dispatch centre to identify AHF. Secondly, we wanted to compare the difficulty of identifying AHF to other common cardiovascular conditions taken care by EMS.

Methods: A survey was sent to EMS leaders on charge of EMS regions covering more than 20% of the countries’ population. The study was designed to cover 12 different European countries (Finland, Denmark, Sweden, Norway, Germany, Poland, Czech Republic, France, Spain, Italy, Switzerland, and United Kingdom). The survey included five common conditions: decompensated chronic heart failure (CHF), de novo AHF, stroke, ST-elevation myocardial infarction (STEMI), acute coronary syndrome (ACS), pulmonary embolism (PE), acute asthma attack (AAA), and sepsis. Difficulty of identifying these conditions was graded through a 5-points qualitative scale from very easy to very difficult. Difficulty was compared between EMS and dispatching centre and among the conditions. For comparisons between decompensated CHF and de novo AHF, we used chi-square test. For comparisons between dispatch centre and EMS and between medical conditions results we transformed into quantitative variables and compared by one-way ANOVA.

Results: We received 34 surveys from 3 countries fulfilling the inclusion criteria: 19 from Spain (covering 40.0 million citizens, 86.0% of the population), 9 from Switzerland (covering 2.3 million, 27.1% of population) and 6 from Finland (covering 3.5 million, 63.3% of population). The percentages of responders considering suspicion of decompensated CHF/de novo AHF at dispatch centre as very or quite easy was 29.0/6.5, medium 38.7/35.5, and quite or very difficult 32.3/58.1 (p=0.034 for comparison between decompensated and de novo), while identifying these conditions by EMS was considered very or quite easy in 64.8/55.9, medium in 29.4/29.4, and quite of very difficult in 5.9/14.7 (p=0.471). For all conditions surveyed, difficulty in suspecting these conditions was higher in dispatch centre than in EMS (p<0.001 in all comparisons). The perceived difficulty in identifying the 8 conditions are shown in Figure .

Conclusions: Interestingly, it is considered rather easy to detect de Novo AHF and decompensated CHF in EMS. Whereas in dispatch centre it is rather difficult.  Also, a surprising finding is that identifying decompensated CHF is considered easier than de novo AHF.  The study also showed that it is more difficult to detect AHF than AAA, STEMI, stroke and ACS but easier than sepsis and PE. A prospective observational study is needed to confirm these findings.