Providing Rapid Out of Hospital Acute Cardiovascular Treatment (PROACT)

• Time from first medical contact to administration of appropriate evidence based therapy. [ Time Frame: From date of first medical contact until first appropriate therapy given, assessed up to 30 months ] [ Designated as safety issue: No ]
  First medical contact is defined as arrival of the paramedics on scene. First appropriate therapy for NSTEMI is defined as: receiving oral antiplatelet agent (excluding ASA) or intravenous/subcutaneous antithrombotic agents. First appropriate therapy for AHF is defined as: IV nitroglycerin, or oral or intravenous furosemide. Final disposition for other diagnoses is a diagnosis, institution of therapy for other diagnosis or admission/discharge for that diagnosis.
  
  

• Time from first medical contact to clinical diagnosis [ Time Frame: From time of first medical contact to clinical diagnosis, assessed up to 30 months ] [ Designated as safety issue: No ]
  
• Time from first medical contact to hospital admission or discharge from emergency - all patients [ Time Frame: From time of first medical contact up to hospital admission or discharge, whichever comes first, assessed up to 30 months ] [ Designated as safety issue: No ]
  
• Length of hospital stay [ Time Frame: From date of first medical contact until hospital discharge, assessed up to 30 months ] [ Designated as safety issue: No ]
  
• In-hospital clinical events - death, shock, HF, re-MI [ Time Frame: From date of first medical contact until hospital discharge, assessed up to 30 months ] [ Designated as safety issue: No ]
  
• 30-day and 1 year mortality [ Time Frame: From date of first medical contact until 1 year or death, whichever comes first, assessed up to 30 months ] [ Designated as safety issue: No ]
  
• 30 day hospitalization or re-hospitalization [ Time Frame: From date of first medical contact until 30 days, assessed up to 30 months ] [ Designated as safety issue: No ]
  
• Cost analysis of implementing pre-hospital point of care analysis [ Time Frame: From date of first medical contact until 1 year, assessed up to 30 months ] [ Designated as safety issue: No ]
  

Utilizing the platform of pre-hospital STEMI research and clinical experience developed over the past decade; we now intend to investigate how best to achieve timely diagnosis and risk stratification of patients that present to pre-hospital emergency medical services with symptoms suspicious for acute NSTEMI or AHF through utilization of systematic clinical assessment, pre-hospital 12 lead electrocardiogram and point of care measurement of biomarkers. We hypothesize that establishing a pre-hospital diagnosis in these conditions may facilitate efficient triage and -as appropriate- in-hospital disposition. Additionally, the enhanced pre-hospital assessment of this population will facilitate appropriate timely disposition of those patients not found to have acute cardiovascular disease. These processes will facilitate decanting the frequently overcrowded and under resources Emergency Departments.