Differences in prehospital emergency medical care between urban and rural regions based on acute coronary syndrome—the MONAH1 study

Differences in medical care between urban and rural regions concern both the availability of medical facilities and the quality and accessibility of care. This work aimed to investigate possible differences in prehospital care-an aspect inadequately examined to date-based on the clinical picture of acute coronary syndrome (ACS). Consecutive patients with a diagnosis of ACS from 2014 to 2018 were included. They had been treated in a prehospital setting by emergency physicians from the district of Börde (rual area; BK) or the city of Magdeburg (urban area; MD). Data were collected from emergency physician protocols (fields to be ticked and the free texts) and subjected to multivariable logistic regression. The results showed that acetylsalicylic acid is given significantly more frequently in BK than in MD, as is heparin. Oxygen is also administered more frequently in BK than in MD, although the difference is barely significant. There is no significant difference between BK and MD in terms of the prehospital performance of a 12-lead ECG. The biggest differences between the groups are in prehospital stay duration (higher in BK due to longer travel times) and heparin administration. In the case of prehospital emergency medical care for ACS, these results refute the frequent claims in the literature of significantly poorer medical care in rural areas: in the rural district of Börde, ACS was generally treated by emergency physicians closer to the guidelines than in the state capital of Magdeburg.