Predictors of Time from Symptom Onset to First Medical Contact in the Digital Telemedicine Era

Background: Available data suggests that further reducing door-to-balloon time may not reduce mortality, but reducing the time from symptom onset to first medical contact (FMC) may by itself improve patient outcome. The purpose of the current analysis was to identify predictors of time delay from onset of symptoms to FMC in the largest private telemedicine database in Israel, SHAHAL Telemedicine Company. Methods: Between January 1996 and October 2017, we identified 24,592 calls of patients with possible ACS based on symptoms and first ECG. For the purpose of the current analysis we included the first call of 13,209 unique patients for whom demographic, clinical ECG data was available. Results: Mean age of the study population was 71±13, 58% were men and 27% had diabetes mellitus. ECG changes included suspected ST elevation in 2,643 (20%) cases and ST depression in 3,602 (27%) cases. There were 2,425 (18%), 1968 (15%) and 1672(13%) calls to the center within 15 minutes, 30 minutes and 1 hour, respectively. 2,263 (17%) patients contacted the center after more than 6 hours of symptoms. A multivariate binary logistic model demonstrated that male gender, irregular rhythm on first ECG and ST elevation or depressions were all independently associated with increased likelihood of contacting the center within less than 1 hour of symptoms (TABLE; p Conclusions: Male gender, ischemic ST changes and irregular heart rate are all associated with short interval between symptom onset and FMC, while older diabetic females with prior history of myocardial infarction have longer time delay to FMC.