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Yufu K, Shimomura T, Kawano K, Sato H, Yonezu K, Saito S, Kondo H, Fukui A, Akioka H, Shinohara T, Teshima Y, Abe R, Takahashi N. Usefulness of Prehospital 12-Lead Electrocardiography System in ST-Segment Elevation Myocardial Infarction Patients in Oita - Comparison Between Urban and Rural Areas, Weekday Daytime and Weekday Nighttime/Holidays. Circ J 2024; 88:1293-1301. [PMID: 37612071 DOI: 10.1253/circj.cj-23-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND We have reported that a prehospital 12-lead electrocardiography system (P-ECG) contributed to transport of suspected acute coronary syndrome (ACS) patients to appropriate institutes and in this study, we compared its usefulness between urban and rural areas, and between weekday daytime and weekday nighttime/holiday. METHODS AND RESULTS Consecutive STEMI patients who underwent successful primary percutaneous coronary intervention after using P-ECG were assigned to the P-ECG group (n=123; 29 female, 70±13 years), and comparable STEMI patients without using P-ECG were assigned to the conventional group (n=117; 33 females, mean age 70±13 years). There was no significant difference in door-to-reperfusion times between the rural and urban cases (70±32 vs. 69±29 min, P=0.73). Door-to-reperfusion times in the urban P-ECG group were shorter than those in the urban conventional group for weekday nighttime/holiday (65±21 vs. 83±32 min, P=0.0005). However, there was no significance different between groups for weekday daytime. First medical contact to reperfusion time (90±22 vs. 105±37 min, P=0.0091) in the urban P-ECG group were significantly shorter than in the urban conventional groups for weekday nighttime/holiday, but were not significantly different between the groups for weekday daytime. CONCLUSIONS P-ECG is useful even in urban areas, especially for patients who develop STEMI during weekday nighttime or while on a holiday.
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Affiliation(s)
- Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | | | - Kyoko Kawano
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shotaro Saito
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Ryuzo Abe
- Advanced Trauma Emergency and Critical Care Center, Oita University Hospital
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
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Sarıçam E, Erdol MA, Bozkurt E, Ilkay E, Cantekin ÖF. New ECG Algorithm for the Prediction of Culprit Vessel in Acute Myocardial Infarction Involving Lateral Part of the Ventricle: Ilkay Classification. Int J Gen Med 2023; 16:2643-2651. [PMID: 37377781 PMCID: PMC10292609 DOI: 10.2147/ijgm.s416376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Background Isolated lateral myocardial infarction sometimes does not meet ST-segment elevation myocardial infarction (STEMI) criteria according to contiguous leads. This condition could cause late diagnosis and the need for revascularization therapy. Aim To accurately predict the occlusion of lateral surface of the left ventricle, we defined a new electrocardiogram (ECG) algorithm by using angiographic and electrocardiographic correlations. Methods This was a retrospective, multicenter observational study. The study population consisted of 200 patients with STEMI affecting lateral surface of myocardium, between 2021 and 2022. According to the coronary angiography results, we identified 74 eligible patients for study protocol. The study patients were divided into two groups: isolated DB (14 patients) or circumflex obtuse marginal group (60 patients). Results ST depression in lead V2 had high positive predictive values for the prediction of obtuse marginal occlusion (positive predictive values (PPV), 100%; negative predictive value (NPV), 90%). ST elevation in V2 in ECG, in conjunction with ST depression in lead III had high positive predictive values for prediction of diagonal branch of LAD. Moreover, the presence of hyperacute T wave (≥10 mm) in lead V2 and ≥2 mm ST depression in lead III had large diagonal branch of LAD (PPV, 98%; NPV, 100%). However, <10 mm T wave in lead V2 and <2 mm ST depression in lead III had small diagonal branch of LAD. Conclusion We comprehensively classified the lateral STEMI definition through new electrocardiographic scheme as Ilkay classification, whereby we could accurately predict infarct-related artery and its occlusion level in lateral myocardial infarction.
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Affiliation(s)
- Ersin Sarıçam
- Department of Cardiology, Medicana International Ankara Hospital, Atılım University, Ankara, Turkey
| | | | - Engin Bozkurt
- Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Erdogan Ilkay
- Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ömer Faruk Cantekin
- Faculty of Health Sciences, Department of Social Work, Gazi University, Ankara, Turkey
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Mahalwar G, Kumar A, Kalra A. Virtual Cardiology: Past, Present, Future Directions, and Considerations. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:117-122. [PMID: 37305213 PMCID: PMC10225773 DOI: 10.1007/s12170-023-00719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/13/2023]
Abstract
Purpose of Review Through this review, we attempt to explore the role of telemedicine and virtual visits in the field of cardiology pre-COVID-19 and during COVID-19 pandemic, their limitations and their future scope for delivery of care. Recent Findings Telemedicine, which rose to prominence during COVID-19 pandemic, helped not only in reducing the burden on the healthcare system during a time of crisis but also in improving patient outcomes. Patients and physicians also favored virtual visits when feasible. Virtual visits were found to have the potential to be continued beyond the pandemic and play a significant role in patient care alongside conventional face-to-face visits. Summary Although tele-cardiology has proven beneficial in terms of patient care, convenience, and access, it comes with its fair share of limitations-both logistical and medical. Whilst there remains a great scope for improvement in the quality of patient care provided through telemedicine, it has shown the potential to become an integral part of medical practice in the future. Supplementary Information The online version contains supplementary material available at 10.1007/s12170-023-00719-0.
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Affiliation(s)
- Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH USA
| | - Ankur Kalra
- Franciscan Physician Network Cardiology, Franciscan Health, 3900 St. Francis Way, Suite 200 Lafayette, IN 47905 Lafayette, USA
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Temporal Trends in Reperfusion Delivery and Clinical Outcomes Following Implementation of a Regional STEMI Protocol – a 12 Year Perspective. CJC Open 2022; 5:181-190. [PMID: 37013074 PMCID: PMC10066451 DOI: 10.1016/j.cjco.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022] Open
Abstract
Background The Vancouver Coastal Health (VCH) ST-elevation myocardial infarction (STEMI) program aimed to increase access to primary percutaneous coronary intervention (PPCI) and reduce first-medical-contact-to-device times (FMC-DTs). We evaluated the long-term program impact on PPCI access and FMC-DT, and overall and reperfusion-specific in-hospital mortality. Methods We analyzed all VCH STEMI patients between June 2007 and November 2019. The primary outcome was the proportion of patients receiving PPCI over 4 program implementation phases over 12 years. We also evaluated overall changes in median FMC-DT and the proportion of patients achieving guideline-mandated FMC-DT, in addition to overall and reperfusion-specific in-hospital mortality. Results A total of 3138 of 4305 VCH STEMI patients were treated with PPCI. PPCI rates increased from 40.2% to 78.7% from 2007 to 2019 (P < 0.001). From phase 1 to 4, median FMC-DT improved from 118 to 93 minutes (percutaneous coronary intervention [PCI]-capable hospitals, P < 0.001) and from 174 to 118 minutes (non-PCI-capable hospitals, P < 0.001), with a concomitant increase in those achieving guideline-mandated FMC-DT (35.5% to 66.1%, P < 0.001). Overall in-hospital mortality was 9.0% (P = 0.20 across phases), with mortality differing significantly by reperfusion strategy (4.0% fibrinolysis, 5.7% PPCI, 30.6% no reperfusion therapy, P < 0.001). Mortality significantly decreased from phase 1 to phase 4 at non-PCI-capable centres (9.6% to 3.9%, P = 0.022) but not at PCI-capable centres (8.7% vs 9.9%, P = 0.27). Conclusions A regional STEMI program increased the proportion of patients who received PPCI and improved reperfusion times over 12 years. Although no statistically significant decrease occurred in overall regional mortality incidence, mortality incidence was decreased for patients presenting to non-PCI-capable centres.
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Chen KW, Wang YC, Liu MH, Tsai BY, Wu MY, Hsieh PH, Wei JT, Shih ESC, Shiao YT, Hwang MJ, Wu YL, Hsu KC, Chang KC. Artificial intelligence-assisted remote detection of ST-elevation myocardial infarction using a mini-12-lead electrocardiogram device in prehospital ambulance care. Front Cardiovasc Med 2022; 9:1001982. [PMID: 36312246 PMCID: PMC9614054 DOI: 10.3389/fcvm.2022.1001982] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/29/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To implement an all-day online artificial intelligence (AI)-assisted detection of ST-elevation myocardial infarction (STEMI) by prehospital 12-lead electrocardiograms (ECGs) to facilitate patient triage for timely reperfusion therapy. Methods The proposed AI model combines a convolutional neural network and long short-term memory (CNN-LSTM) to predict STEMI on prehospital 12-lead ECGs obtained from mini-12-lead ECG devices equipped in ambulance vehicles in Central Taiwan. Emergency medical technicians (EMTs) from the 14 AI-implemented fire stations performed the on-site 12-lead ECG examinations using the mini portable device. The 12-lead ECG signals were transmitted to the AI center of China Medical University Hospital to classify the recordings as "STEMI" or "Not STEMI". In 11 non-AI fire stations, the ECG data were transmitted to a secure network and read by available on-line emergency physicians. The response time was defined as the time interval between the ECG transmission and ECG interpretation feedback. Results Between July 17, 2021, and March 26, 2022, the AI model classified 362 prehospital 12-lead ECGs obtained from 275 consecutive patients who had called the 119 dispatch centers of fire stations in Central Taiwan for symptoms of chest pain or shortness of breath. The AI's response time to the EMTs in ambulance vehicles was 37.2 ± 11.3 s, which was shorter than the online physicians' response time from 11 other fire stations with no AI implementation (113.2 ± 369.4 s, P < 0.001) after analyzing another set of 335 prehospital 12-lead ECGs. The evaluation metrics including accuracy, precision, specificity, recall, area under the receiver operating characteristic curve, and F1 score to assess the overall AI performance in the remote detection of STEMI were 0.992, 0.889, 0.994, 0.941, 0.997, and 0.914, respectively. During the study period, the AI model promptly identified 10 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) with a median contact-to-door time of 18.5 (IQR: 16-20.8) minutes. Conclusion Implementation of an all-day real-time AI-assisted remote detection of STEMI on prehospital 12-lead ECGs in the field is feasible with a high diagnostic accuracy rate. This approach may help minimize preventable delays in contact-to-treatment times for STEMI patients who require PPCI.
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Affiliation(s)
- Ke-Wei Chen
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Yu-Chen Wang
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- Division of Cardiovascular Medicine, Asia University Hospital, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
| | - Meng-Hsuan Liu
- AI Center for Medical Diagnosis, China Medical University Hospital, Taichung, Taiwan
| | - Being-Yuah Tsai
- AI Center for Medical Diagnosis, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Yao Wu
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | | | - Jung-Ting Wei
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | | | - Yi-Tzone Shiao
- Center of Institutional Research and Development, Asia University, Taichung, Taiwan
| | - Ming-Jing Hwang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ya-Lun Wu
- AI Center for Medical Diagnosis, China Medical University Hospital, Taichung, Taiwan
| | - Kai-Cheng Hsu
- AI Center for Medical Diagnosis, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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Kubica J, Adamski P, Ładny JR, Kaźmierczak J, Fabiszak T, Filipiak KJ, Gajda R, Gąsior M, Gąsior Z, Gil R, Gorący J, Grajek S, Gromadziński L, Gruchała M, Grześk G, Hoffman P, Jaguszewski MJ, Janion M, Jankowski P, Kalarus Z, Kasprzak JD, Kleinrok A, Kochman W, Kubica A, Kuliczkowski W, Legutko J, Lesiak M, Nadolny K, Navarese EP, Niezgoda P, Ostrowska M, Paciorek P, Siller-Matula J, Szarpak Ł, Timler D, Witkowski A, Wojakowski W, Wysokiński A, Zielińska M. Pre-hospital treatment of patients with acute coronary syndrome: Recommendations for medical emergency teams. Expert position update 2022. Cardiol J 2022; 29:540-552. [PMID: 35514089 PMCID: PMC9273237 DOI: 10.5603/cj.a2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/31/2022] [Accepted: 04/24/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jacek Kubica
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Adamski
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
| | - Jerzy R Ładny
- Department of Emergency Medicine Medical University of Bialystok, Poland
| | | | - Tomasz Fabiszak
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Medicine, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | | | - Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Robert Gil
- Mossakowski Medical Research Institute, Polish Academy of Science, Warsaw, Poland
| | - Jarosław Gorący
- Independent Laboratory of Invasive Cardiology, Pomeranian Medical University, Szczecin, Poland
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Stefan Grajek
- Ist Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Leszek Gromadziński
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Marcin Gruchała
- Ist Department of Cardiology, Medical University of Gdańsk, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Nicolaus Copernicus University, Toruń, Poland
| | - Piotr Hoffman
- Department of Congenital Heart Defects, National Institute of Cardiology, Warszawa, Poland
| | | | - Marianna Janion
- Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Epidemiology and Health Promotion, School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Zbigniew Kalarus
- 2nd Chair and Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jarosław D Kasprzak
- 1st Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Łódź, Poland
| | - Andrzej Kleinrok
- University of Information Technology and Management in Rzeszów, Poland
| | - Wacław Kochman
- The National Institute of Cardiology, Department of Cardiology, Bielanski Hospital, Warsaw, Poland
| | - Aldona Kubica
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Poland
| | - Maciej Lesiak
- Ist Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Eliano P Navarese
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Niezgoda
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | | | - Jolanta Siller-Matula
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland
- Department of Cardiology, Medical University of Vienna, Austria
| | - Łukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Marzenna Zielińska
- Department of Invasive Cardiology, Medical University of Lodz, Lodz, Poland
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7
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The Telecardiology Revolution: From Emergency Management to Daily Clinical Practice. J Clin Med 2022; 11:jcm11071920. [PMID: 35407529 PMCID: PMC8999803 DOI: 10.3390/jcm11071920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/16/2022] Open
Abstract
AIMS Telecardiology is one of the most widespread applications of telemedicine. We aimed to report the design and development of a telecardiology system in the sanitary district of Cosenza, one of the largest in Italy, with a complex orography, and healthcare reorganization needs, for the management of the emergency network and daily clinical practice. METHODS Our telecardiology network connects 8 hospitals, 9 first aid centers, 20 local 118-EMS stations, 1 helicopter station, 8 hospital emergency departments, 59 hospital departments, and 3 catheterization laboratories. All data are centralized on a dedicated server, accessible from any location for real-time assessment. The quality, source, and timing of the electrocardiograms transmitted were evaluated. RESULTS From October 2015 to December 2019, a total of 389,970 ECGs were transmitted. The quality of ECGs was optimal in 52%, acceptable in 42%, and poor in 6% of the cases. The number of poor-quality ECGs was only 3% in the last 2 years. Out of the total, 145,097 (37.2%) were transmitted from the emergency departments and 5318 (1.4%) from the 118-EMS. Of interest, a sizable part of the ECG was related to routine clinical practice, comprising 110,556 (28.3%) from the cardiology department and 79,256 (20.3%) from other noncardiovascular departments. Finally, the average reporting time was significantly decreased compared to reporting times without a telecardiology system (5-10 vs. 45-90 min). CONCLUSION Our telecardiology system provides efficient cardiology assistance for all types, settings, and phases of cardiovascular diseases.
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Khoury A. Heparin still one of the most important reperfusion therapies for ST-elevation myocardial infarction in out-of-hospital settings. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:1148-1149. [PMID: 34864961 DOI: 10.1093/ehjacc/zuab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Abdo Khoury
- Department of Emergency Medicine and Critical Care, Besançon University Hospital, 25030 Besançon CEDEX, Boulevard Fleming, France
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Matsuzawa Y, Kosuge M, Fukui K, Suzuki H, Kimura K. Present and Future Status of Cardiovascular Emergency Care System in Urban Areas of Japan - Importance of Prehospital 12-Lead Electrocardiogram. Circ J 2021; 86:591-599. [PMID: 34690225 DOI: 10.1253/circj.cj-21-0807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Acute cardiovascular disease, such as acute myocardial infarction and aortic disease, can lead to a serious life-threatening state within minutes to hours, so early accurate diagnosis, and appropriate treatment without delay are essential. To provide high-quality and timely treatment, 24-h availability of medical staff and cardiologists, as well as a cardiac catheterization laboratory are needed. In Japan, the number of patients with acute cardiovascular disease is increasing with the aging population and westernization of lifestyle; however, workstyle reforms for physicians, including a policy to limit overtime work, have been legislated. Under these conditions, it is necessary to centralize hospitals that treat cardiovascular emergency diseases as high-volume centers and build a patient triage system for allocating patients before hospital arrival. The prehospital 12-lead electrocardiogram (ECG) plays a central role in prehospital diagnosis and triage, and its importance will increase in future. We discuss the current and future state of the cardiovascular emergency medical care system utilizing prehospital 12-lead ECG in urban areas of Japan.
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Affiliation(s)
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
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Ozkalayci F, Türkyılmaz E, Karagoz A, Karabay CY, Tanboga İH, Oduncu V. A Clinical Score to Predict "Corrected Thrombolysis in Myocardial Infarction Frame Count" in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology 2021; 73:365-373. [PMID: 34625005 DOI: 10.1177/00033197211045021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Corrected thrombolysis in myocardial infarction frame count (cTFC) is an objective, simple, and reproducible method to assess coronary blood flow which is a surrogate for cardiovascular outcomes. It is important to learn which factors are associated with cTFC. The goal of this study was to determine predictive models for epicardial blood flow assessed by cTFC and develop a diagnostic predictive model that indicates the individualized assessment of epicardial blood flow prior to primary percutaneous coronary intervention. This is a retrospective study including 3205 patients with ST-segment elevation myocardial infarction who underwent pPCI. The primary outcome was cTFC. Multivariable linear regression analysis was performed. Subsequently, a nomogram was developed to predict cTFC according to the candidate predictors. Median age was 58; the number of male patients was 2381 (74.3%). Median value of cTFC was 22 and interquartile range (IQR): 16.5-28.0). Age, diabetes mellitus (DM), total ischemic time, systolic blood pressure (SBP), heart rate (HR), and history of statin use remained in both full and reduced models. Our model may potentially allow clinicians to identify patients at high risk for impaired epicardial perfusion.
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Affiliation(s)
- Flora Ozkalayci
- Department of Cardiology, Hisar Intercontinental Hospital, İstanbul, Turkey
| | - Erdem Türkyılmaz
- Department of Cardiology, Uşak Training and Research Hospital, Uşak, Turkey
| | - Ali Karagoz
- Department of Cardiology, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Can Yucel Karabay
- Department of Cardiology, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - İbrahim Halil Tanboga
- Department of Cardiology, Hisar Intercontinental Hospital, İstanbul, Turkey.,Department of Biostatistics, School of Medicine, Nişantaşı University, İstanbul, Turkey
| | - Vecih Oduncu
- Department of Cardiology, Bahçesehir University Hospital, İstanbul, Turkey
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11
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Fang HY, Lee WC. Warning system improve the clinical outcomes in transfer patients with ST-segment elevation myocardial infarction. Medicine (Baltimore) 2021; 100:e26558. [PMID: 34190194 PMCID: PMC8257831 DOI: 10.1097/md.0000000000026558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/12/2021] [Indexed: 01/04/2023] Open
Abstract
A warning system included directly faxing electrocardiography information to the mobile phone immediately after an ST-segment elevation myocardial infarction (STEMI) diagnosis was made at a non-percutaneous coronary intervention (PCI) capable hospital. This study aimed to explore the outcomes after using a warning system in transfer STEMI patients.From October 2013 to December 2016, 667 patients experienced a STEMI event and received primary PCI at our institution. 274 patients who were divided into transfer group were transferred from non-PCI capable hospitals and connected to a first-line cardiovascular doctor by the warning system. Other 393 patients were divided into the non-transfer group.The transfer group still had a longer pain-to-reperfusion time and presented higher troponin-I level when compared with non-transfer group. There was no significant difference in the use of drug-eluting stent and procedural devices between non-transfer and transfer groups. The prevalence of different anti-platelet agents loading did not differ between non-transfer and transfer groups. Non-significant trend about higher prevalence of statin use was noted in transfer group (78.9% vs 86.1%, P = .058). The transfer group presented similar clinical short-term results regarding both cardiovascular and all-cause mortality when comparing with non-transfer group. The transfer group provided non-significant trend about lower one-year cardiovascular mortality (10.7% vs 6.2%, P = .052) and lower all-cause mortality (12.2% vs 6.9%, P = .026) when compared with non-transfer group. There was a significant difference in the Kaplan-Meier curve of 1-year cardiovascular mortality between the transfer group and the non-transfer group (P = .049).After using the warning system, the inter-facility transfer group had comparable outcomes even though a longer pain-to-reperfusion time and a higher peak troponin-I level when comparing with non-transfer group.
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Sturm RC, Jones TL, Youngquist ST, Shah RU. Regional Systems of Care in ST Elevation Myocardial Infarction. Interv Cardiol Clin 2021; 10:281-291. [PMID: 34053615 DOI: 10.1016/j.iccl.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ST-segment elevation myocardial infarction is a medical emergency with significant health care delivery challenges to ensure rapid triage and treatment. Several developments over the past decades have led to improved care delivery, decreased time to reperfusion, and decreased mortality. Still, significant challenges remain to further optimize the delivery of care for this patient population.
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Affiliation(s)
- Robert C Sturm
- Division of Cardiovascular Medicine, University of Utah, 30 N. 1900 E, Room 4A100, Salt Lake City, UT, 84132, USA.
| | - Tara L Jones
- Division of Cardiovascular Medicine, University of Utah, 30 N. 1900 E, Room 4A100, Salt Lake City, UT, 84132, USA
| | - Scott T Youngquist
- Division of Emergency Medicine, University of Utah, 30 N 1900 E 1C026, Salt Lake City, UT 84132, USA
| | - Rashmee U Shah
- Division of Cardiovascular Medicine, University of Utah, 30 N. 1900 E, Room 4A100, Salt Lake City, UT, 84132, USA
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13
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Sato N, Minami Y, Ako J, Maeda A, Akashi Y, Ikari Y, Ebina T, Tamura K, Namiki A, Fukui K, Michishita I, Kimura K, Suzuki H. Clinical significance of prehospital 12-lead electrocardiography in patients with ST-segment elevation myocardial infarction presenting with syncope: from a multicenter observational registry (K-ACTIVE study). Heart Vessels 2021; 36:1466-1473. [PMID: 33710375 DOI: 10.1007/s00380-021-01832-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Patients with acute myocardial infarction (AMI) presenting with syncope have poor clinical outcomes partly due to a delay in the diagnosis. Although the impact of prehospital 12-lead electrocardiography (PHECG) on the reduction of first medical contact (FMC)-to-device time and subsequent adverse clinical events in patients with AMI has been demonstrated, the impact of PHECG for the patients presenting with syncope remains to be elucidated. This study aimed to explore the impact of PHECG on 30-day mortality in patients with ST-segment elevation myocardial infarction (STEMI) presenting with syncope. From a cohort of multi-center registry [Kanagawa-ACuTe cardIoVascular rEgistry (K-ACTIVE)], a total of 90 consecutive patients with STEMI presenting with syncope were included. The 30-day mortality were compared between patients with PHECG (PHECG group, n = 25) and those without PHECG (non-PHECG group, n = 65). There was no significant difference in the baseline clinical characteristics between the 2 groups. FMC-to-device time was significantly shorter in the PHECG group than in the non-PHECG group (122 [86, 128] vs. 131 [102, 153] min, p = 0.03) due to the shorter door-to-device time. Thirty-day mortality was significantly lower in the PHECG group than in the non-PHECG group (16.0 vs. 44.6%, p = 0.03). In conclusion, PHECG was associated with shorter FMC-to-device time and lower 30-day mortality in patients with STEMI presenting with syncope.
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Affiliation(s)
- Nobuhiro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0375, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0375, Japan.
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0375, Japan
| | - Atsuo Maeda
- Showa University Fujigaoka Hospital, Yokohama, Japan
| | | | - Yuji Ikari
- Tokai University School of Medicine, Isehara, Japan
| | - Toshiaki Ebina
- Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | - Kazuki Fukui
- Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | - Kazuo Kimura
- Yokohama City University Medical Center, Yokohama, Japan
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De Bonis S, Salerno N, Bisignani A, Capristo A, Sosto G, Verta A, Borselli R, Capristo C, Bisignani G. Cardiology emergency management and telecardiology within territorial hospital network. Four years activity results. Am J Emerg Med 2021; 48:347-350. [PMID: 33526347 DOI: 10.1016/j.ajem.2021.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Silvana De Bonis
- Department of Cardiology, Ospedale "Ferrari", Castrovillari, CS, Italy
| | - Nadia Salerno
- Department of Cardiology, Ospedale "Ferrari", Castrovillari, CS, Italy
| | - Antonio Bisignani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Gennaro Sosto
- Direzione Generale ASL Napoli 3 - Coordinatore Area Innovazione e Tecnologie Sanitarie di Federsanità, Italy
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15
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Szabó GT, Ágoston A, Csató G, Rácz I, Bárány T, Uzonyi G, Szokol M, Sármán B, Jebelovszki É, Édes IF, Czuriga D, Kolozsvári R, Csanádi Z, Édes I, Kőszegi Z. Predictors of Hospital Mortality in Patients with Acute Coronary Syndrome Complicated by Cardiogenic Shock. SENSORS (BASEL, SWITZERLAND) 2021; 21:969. [PMID: 33535491 PMCID: PMC7867036 DOI: 10.3390/s21030969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022]
Abstract
As demonstrated by earlier studies, pre-hospital triage with trans-telephonic electrocardiogram (TTECG) and direct referral for catheter therapy shows great value in the management of out-of-hospital chest pain emergencies. It does not only improve in-hospital mortality in ST-segment elevation myocardial infarction, but it has also been identified as an independent predictor of higher in-hospital survival rate. Since TTECG-facilitated triage shortens both transport time and percutaneous coronary intervention (PCI)-related procedural time intervals, it was hypothesized that even high-risk patients with acute coronary syndrome (ACS) and cardiogenic shock (CS) might also benefit from TTECG-based triage. Here, we decided to examine our database for new triage- and left ventricular (LV) function-related parameters that can influence in-hospital mortality in ACS complicated by CS. ACS patients were divided into two groups, namely, (1) hospital death patients (n = 77), and (2) hospital survivors (control, n = 210). Interestingly, TTECG-based consultation and triage of CS and ACS patients were confirmed as significant independent predictors of lower hospital mortality risk (odds ratio (OR) 0.40, confidence interval (CI) 0.21-0.76, p = 0.0049). Regarding LV function and blood chemistry, a good myocardial reperfusion after PCI (high area at risk (AAR) blush score/AAR LV segment number; OR 0.85, CI 0.78-0.98, p = 0.0178) and high glomerular filtration rate (GFR) value at the time of hospital admission (OR 0.97, CI 0.96-0.99, p = 0.0042) were the most crucial independent predictors of a decreased risk of in-hospital mortality in this model. At the same time, a prolonged time interval between symptom onset and hospital admission, successful resuscitation, and higher peak creatine kinase activity were the most important independent predictors for an increased risk of in-hospital mortality. In ACS patients with CS, (1) an early TTECG-based teleconsultation and triage, as well as (2) good myocardial perfusion after PCI and a high GFR value at the time of hospital admission, appear as major independent predictors of a lower in-hospital mortality rate.
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Affiliation(s)
- Gábor Tamás Szabó
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - András Ágoston
- The III: Department of Internal Medicine, Szabolcs–Szatmár–Bereg County Hospitals and University Teaching Hospital, 4400 Nyíregyháza, Hungary;
| | - Gábor Csató
- Hungarian National Ambulance Service, 1024 Budapest, Hungary;
| | - Ildikó Rácz
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Tamás Bárány
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Gábor Uzonyi
- Department of Cardiology, Uzsoki Hospital, 1145 Budapest, Hungary; (G.U.); (B.S.)
| | - Miklós Szokol
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Balázs Sármán
- Department of Cardiology, Uzsoki Hospital, 1145 Budapest, Hungary; (G.U.); (B.S.)
| | - Éva Jebelovszki
- Department of Cardiology, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary;
| | - István Ferenc Édes
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary;
| | - Dániel Czuriga
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Rudolf Kolozsvári
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Zoltán Csanádi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - István Édes
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Zsolt Kőszegi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
- The III: Department of Internal Medicine, Szabolcs–Szatmár–Bereg County Hospitals and University Teaching Hospital, 4400 Nyíregyháza, Hungary;
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Vodička S, Susič AP, Zelko E. Implementation of a Savvy Mobile ECG Sensor for Heart Rhythm Disorder Screening at the Primary Healthcare Level: An Observational Prospective Study. MICROMACHINES 2021; 12:55. [PMID: 33466536 PMCID: PMC7824824 DOI: 10.3390/mi12010055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/03/2021] [Accepted: 01/03/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The Jozef Stefan Institute developed a personal portable electrocardiogram (ECG) sensor Savvy that works with a smartphone, and this was used in our study. This study aimed to analyze the usefulness of telecardiology at the primary healthcare level using an ECG personal sensor. METHODS We included 400 patients with a history of suspected rhythm disturbance who visited their family physician at the Healthcare Center Ljubljana and Healthcare Center Murska Sobota from October 2016 to January 2018. RESULTS The study found that there was no statistically significant difference between the test and control groups in the number of present rhythm disorders and actions taken to treat patients with either observation or administration of a new drug. However, in the test group, there were significantly fewer patients being referred to a cardiologist than in the control group (p < 0.001). DISCUSSION The use of an ECG sensor helps family physicians to distinguish between patients who need to be referred to a cardiologist and those who can be treated by them. This method is useful for both physicians and patients because it shortens the time taken to start treatment, can be used during pandemics such as COVID-19, and reduces unnecessary cost.
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Affiliation(s)
- Staša Vodička
- Healthcare Center Murska Sobota, 9000 Murska Sobota, Slovenia
| | | | - Erika Zelko
- Department of Family Medicine, Medical Faculty, University of Maribor, 2000 Maribor, Slovenia;
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Hudzik B, Budaj A, Gierlotka M, Witkowski A, Wojakowski W, Zdrojewski T, Gil R, Legutko J, Bartuś S, Buszman P, Dudek D, Gąsior M. Assessment of quality of care of patients with ST-segment elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:893-901. [DOI: 10.1177/2048872619882360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims:
The 2017 European Society of Cardiology guidelines for the management of ST-elevation myocardial infarction recommended assessing quality of care to establish measurable quality indicators in order to ensure that every ST-elevation myocardial infarction patient receives the best possible care. We investigated the quality indicators of healthcare services in Poland provided to ST-elevation myocardial infarction patients.
Methods and results:
The Polish Registry of Acute Coronary Syndromes is a nationwide, multicentre, prospective study of acute coronary syndrome patients in Poland. For the purpose of assessing quality indicators, we included 8279 patients from the Polish Registry of Acute Coronary Syndromes hospitalised with ST-elevation myocardial infarction in 2018. Four hundred and eight of 8279 patients (4.9%) arrived at percutaneous coronary intervention centre by self-transport, 4791 (57.9%) arrived at percutaneous coronary intervention centre by direct emergency medical system transport, and 2900 (37.2%) were transferred from non-percutaneous coronary intervention facilities. Whilst 95.1% of ST-elevation myocardial infarction patients arriving in the first 12 h received reperfusion therapy, the rates of timely reperfusion were much lower (ranging from 39.4% to 55.0% for various ST-elevation myocardial infarction pathways). The median left ventricular ejection fraction was 46% and was assessed before discharge in 86.0% of patients. Four hundred and eighty-nine of 8279 patients (5.9%) died during hospital stay. Optimal medical therapy is prescribed in 50–85% of patients depending on various clinical settings. Only one in two ST-elevation myocardial infarction patients is enrolled in a cardiac rehabilitation program at discharge. No patient-reported outcomes were recorded in the Polish Registry of Acute Coronary Syndromes.
Conclusions:
The results of this study identified areas of healthcare system that require solid improvement. These include direct transport to percutaneous coronary intervention centre, timely reperfusion, guidelines-based medical therapy (in particular in patients with heart failure), referral to cardiac rehabilitation/secondary prevention programs. Also, there is a need for recording quality indicators associated with patient-reported outcomes.
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Affiliation(s)
- Bartosz Hudzik
- 3rd Department of Cardiology, Silesian Centre for Heart Disease, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiovascular Disease Prevention, Faculty of Health Sciences in Bytom, Medical University of Silesia, Katowice, Poland
| | - Andrzej Budaj
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | | | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Poland
| | - Wojciech Wojakowski
- 3rd Department of Cardiology, Upper Silesian Cardiology Centre, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdansk, Poland
| | - Robert Gil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Jagiellonian University Medical College, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Poland
| | - Paweł Buszman
- Centre for Cardiovascular Research and Development, American Heart of Poland, Poland
| | - Dariusz Dudek
- Second Department of Cardiology, Jagiellonian University Medical College, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Centre for Heart Disease, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Prehospital management of patients with suspected acute coronary syndrome : Real world experience reflecting current guidelines. Med Klin Intensivmed Notfmed 2020; 116:694-697. [PMID: 33030581 PMCID: PMC8566385 DOI: 10.1007/s00063-020-00739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/05/2020] [Accepted: 09/02/2020] [Indexed: 12/03/2022]
Abstract
Background In case of suspected acute coronary syndrome (ACS), international guidelines recommend to obtain a 12-lead ECG as soon as possible after first medical contact, to administrate platelet aggregation inhibitors and antithrombins, and to transfer the patient as quickly as possible to an emergency department. Methods A German emergency care service database was retrospectively analysed from 2014 to 2016. Data were tested for normal distribution and the Mann–Whitney test was used for statistical analysis. Results are presented as medians (IQR). Results A total of 1424 patients with suspected ACS were included in the present analysis. A 12-lead ECG was documented in 96% of patients (n = 1369). The prehospital incidence of ST-segment elevation myocardial infarction (STEMI) was 18% (n = 250). In 981 patients (69%), acetylsalicylic acid (ASA), unfractionated heparin (UFH), or ASA and UFH was given. Time in prehospital care differed significantly between non-STEMI (NSTEMI) ACS (37 [IQR 30, 44] min) and STEMI patients (33 [IQR 26, 40] min, n = 1395, p < 0.0001). Most of NSTEMI ACS and STEMI patients were brought to the emergency care unit, while 30% of STEMI patients were directly handed over to a cardiac catheterization laboratory. Conclusions Prehospital ECG helps to identify patients with STEMI, which occurs in 18% of suspected ACS. Patients without ST-elevations suffered from longer prehospital care times. Thus, it is tempting to speculate that ST-elevations in patients prompt prehospital medical teams to act more efficiently while the absence of ST-elevations even in patients with suspected ACS might cause unintended delays. Moreover, this analysis suggests the need for further efforts to make the cardiac catheterization laboratory the standard hand-over location for all STEMI patients.
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19
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Alizadeh R, Aghsaeifard Z, Sadeghi M, Hassani P, Saberian P. Effects of Prehospital Traige and Diagnosis of ST Segment Elevation Myocardial Infarction on Mortality Rate. Int J Gen Med 2020; 13:569-575. [PMID: 32943908 PMCID: PMC7481285 DOI: 10.2147/ijgm.s260828] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Adverse outcomes and mortality associated with STEMI (ST segment elevation myocardial infarction) are associated with the management and diagnosis time. The aim of this study is to evaluate the outcomes of prehospital diagnosis of STEMI via emergency medical service (EMS) on mortality, in comparison to the patients who did not receive EMS. METHODS This retrospective study included STEMI patients, who underwent primary angioplasty. The patients were categorized as group A: referred without emergency service, group B: patients who did not receive PPCI and group C: patients referred via ambulance and received telecardiology. Medical records of these patients were evaluated for the diagnosis time, door-to-balloon time, in-hospital, six months, one year and three-year mortality, left ventricular ejection fraction and previous history of cardiovascular conditions and surgeries. The data were recorded and statistically analyzed using SPSS v21. RESULTS Of 424 patients studied, 79 were referred without emergency service (group A), 52 patients did not receive PPCI (group B) and 293 patients were referred via ambulance with telecardiology (group C). Door-to-balloon time was least in group C (57.78 min) compared to group A (141.70 min). In-hospital, six months, one year and three-year mortality was least in group C, however, the difference was not statistically significant. The left ventricular ejection fraction was significantly greater in group C. CONCLUSION The results of our study indicate that prehospital diagnosis and telecardiology significantly reduce door-to-balloon time in STEMI patients referred for percutaneous intervention and might have an influence on short-term and long-term mortality rates.
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Affiliation(s)
- Reza Alizadeh
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Ziba Aghsaeifard
- Department of Internal Medicine, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran,Iran
| | - Mostafa Sadeghi
- Department of Anesthesiology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Hassani
- School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Saberian
- Department of Anesthesiology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Park J, Choi KH, Lee JM, Kim HK, Hwang D, Rhee TM, Kim J, Park TK, Yang JH, Song YB, Choi JH, Hahn JY, Choi SH, Koo BK, Chae SC, Cho MC, Kim CJ, Kim JH, Jeong MH, Gwon HC, Kim HS. Prognostic Implications of Door-to-Balloon Time and Onset-to-Door Time on Mortality in Patients With ST -Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2020; 8:e012188. [PMID: 31041869 PMCID: PMC6512115 DOI: 10.1161/jaha.119.012188] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background In patients with ST-segment-elevation myocardial infarction, timely reperfusion therapy with door-to-balloon (D2B) time <90 minutes is recommended by the current guidelines. However, whether further shortening of symptom onset-to-door (O2D) time or D2B time would enhance survival of patients with ST-segment-elevation myocardial infarction remains unclear. Therefore, the current study aimed to evaluate the prognostic impact of O2D or D2B time in patients with ST-segment-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Methods and Results We analyzed 5243 patients with ST-segment-elevation myocardial infarction were treated at 20 tertiary hospitals capable of primary percutaneous coronary intervention in Korea. The association between O2D or D2B time with all-cause mortality at 1 year was evaluated. The median O2D time was 2.0 hours, and the median D2B time was 59 minutes. A total of 92.2% of the total population showed D2B time ≤90 minutes. In univariable analysis, 1-hour delay of D2B time was associated with a 55% increased 1-year mortality, whereas 1-hour delay of O2D time was associated with a 4% increased 1-year mortality. In multivariable analysis, D2B time showed an independent association with mortality (adjusted hazard ratio, 1.90; 95% CI , 1.51-2.39; P<0.001). Reducing D2B time within 45 minutes showed further decreased risk of mortality compared with D2B time >90 minutes (adjusted hazard ratio, 0.30; 95% CI , 0.19-0.42; P<0.001). Every reduction of D2B time by 30 minutes showed continuous reduction of 1-year mortality (90 to 60 minutes: absolute risk reduction, 2.4%; number needed to treat, 41.9; 60 to 30 minutes: absolute risk reduction, 2.0%; number needed to treat, 49.2). Conclusions Shortening D2B time was significantly associated with survival benefit, and the survival benefit of shortening D2B time was consistently observed, even <60 to 90 minutes.
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Affiliation(s)
- Jonghanne Park
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.,2 Department of Internal Medicine Naju National Hospital Jeollanam-do Korea
| | - Ki Hong Choi
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Joo Myung Lee
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Hyun Kuk Kim
- 4 Department of Internal Medicine and Cardiovascular Center Chosun University Hospital University of Chosun College of Medicine Gwangju Korea
| | - Doyeon Hwang
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
| | - Tae-Min Rhee
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.,5 National Maritime Medical Center Changwon Korea
| | - Jihoon Kim
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Taek Kyu Park
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jeong Hoon Yang
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Young Bin Song
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jin-Ho Choi
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Joo-Yong Hahn
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Seung-Hyuk Choi
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Bon-Kwon Koo
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
| | | | - Myeong Chan Cho
- 7 Cardiology Division Department of Internal Medicine Chungbuk National University Hospital Cheongju Korea
| | - Chong Jin Kim
- 8 Department of Internal Medicine Kyunghee University College of Medicine Seoul Korea
| | - Ju Han Kim
- 9 Department of Internal Medicine and Heart Center Chonnam National University Hospital Gwangju Korea
| | - Myung Ho Jeong
- 9 Department of Internal Medicine and Heart Center Chonnam National University Hospital Gwangju Korea
| | - Hyeon-Cheol Gwon
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Hyo-Soo Kim
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
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21
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Vodička S, Naji HF, Zelko E. The Role of Telecardiology in Dealing with Patients with Cardiac Rhythm Disorders in Family Medicine - Systematic Review. Zdr Varst 2020; 59:108-116. [PMID: 32952710 PMCID: PMC7478077 DOI: 10.2478/sjph-2020-0014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/02/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Heart rhythm disorders (HRD) are often present in patients visiting their family physician (FP). Dealing with their problems is not always simple, efficient and cost effective. The aim of this paper is to review the existing literature about the use and experience of telecardiology in patients experiencing HRD. METHODS We conducted a review of literature in PubMed biographical databases (MeSH thesaurus), Web of Science and Cochrane, between 1995 and 2019. We included original articles in English that describe the use of telecardiology at primary and secondary healthcare levels. Exclusion criteria are those publications that discuss heart failure or observation of the activity of pacemakers or defibrillators and the age of patients under 18 years. A total of 19 papers met the inclusion criteria, thirteen of them were original scientific articles and we included them in the analysis. RESULTS Use of telemedicine can shorten the time from diagnosis to the necessary treatment (2/13), telemedicine can reduce mortality in patients with acute myocardial infarction (4/13), it can shorten the time to diagnose atrial fibrillations (4/13), it can help determine the diagnosis for patients complaining about heart rhythm disorders which were not detected on the standard ECG recording (2/13) and can also help identify cardiac causes for syncope or collapse (2/13). All studies have confirmed that the use of telecardiology significantly reduces the number of unnecessary referrals to a cardiologist or hospitalization, and shortens the time needed to treat patients with life-threatening conditions. CONCLUSION The use of telecardiological techniques increases the quality and safety of work in managing patients with cardiovascular disease in FP practice. Usage of telecardiologic devices can also save money and bridge the gap between the primary and secondary healthcare levels.
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Affiliation(s)
- Staša Vodička
- Community Health Centre Murska Sobota, Grajska ulica 24, 9000Murska Sobota, Slovenia
| | - Husam Franjo Naji
- University Medical Centre Maribor, Ljubljanska ul. 5, 2000, Maribor, Slovenia
| | - Erika Zelko
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
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2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Guidelines on the Acute Management of ST-Elevation Myocardial Infarction: Focused Update on Regionalization and Reperfusion. Can J Cardiol 2019; 35:107-132. [PMID: 30760415 DOI: 10.1016/j.cjca.2018.11.031] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022] Open
Abstract
Rapid reperfusion of the infarct-related artery is the cornerstone of therapy for the management of acute ST-elevation myocardial infarction (STEMI). Canada's geography presents unique challenges for timely delivery of reperfusion therapy for STEMI patients. The Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology STEMI guideline was developed to provide advice regarding the optimal acute management of STEMI patients irrespective of where they are initially identified: in the field, at a non-percutaneous coronary intervention-capable centre or at a percutaneous coronary intervention-capable centre. We had also planned to evaluate and incorporate sex and gender considerations in the development of our recommendations. Unfortunately, inadequate enrollment of women in randomized trials, lack of publication of main outcomes stratified according to sex, and lack of inclusion of gender as a study variable in the available literature limited the feasibility of such an approach. The Grading Recommendations, Assessment, Development, and Evaluation system was used to develop specific evidence-based recommendations for the early identification of STEMI patients, practical aspects of patient transport, regional reperfusion decision-making, adjunctive prehospital interventions (oxygen, opioids, antiplatelet therapy), and procedural aspects of mechanical reperfusion (access site, thrombectomy, antithrombotic therapy, extent of revascularization). Emphasis is placed on integrating these recommendations as part of an organized regional network of STEMI care and the development of appropriate reperfusion and transportation pathways for any given region. It is anticipated that these guidelines will serve as a practical template to develop systems of care capable of providing optimal treatment for a wide range of STEMI patients.
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Yekefallah L, Pournorooz M, Noori H, Alipur M. Evaluation of Door-To-Balloon Time for Performing Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients Transferred by Pre-Hospital Emergency System in Tehran. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:281-285. [PMID: 31333742 PMCID: PMC6621504 DOI: 10.4103/ijnmr.ijnmr_130_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: The suggested treatment for patients with ST-segment elevation is the Primary Percutaneous Coronary Intervention (PPCI) for coronary reperfusion. This study aimed to evaluate the contribution of pre-hospital and hospital emergency systems in the interval time for PPCI among patients with the ST-segment elevation myocardial infarction (STEMI) in selected hospitals of Tehran city. Materials and Methods: This cross-sectional study was carried out on patients with typical chest pain transferred to the emergency wards of three large general hospitals in Tehran city by Emergency Medical Services. They received the PPCI. The information about admission time to the triage, time of conducting electrocardiography (ECG), diagnosis time of STEMI, and time of the PPCI were recorded and analyzed using descriptive and inferential statistics. Results: In this study, 121 patients were evaluated, and of which 94 (77.68%) were men and 27 (22.32%) were women. The average time (SD) of patient admission in the triage until to receive the PPCI (door-to-balloon) was 104.60 (62.30) min. Conclusions: The door-to-balloon time was 104.60 min. If ECG is taken by pre-hospital emergency nursing staff and diagnosis of STEMI is performed by the pre-hospital emergency service, and the patient is delivered directly to the angiography department, the door-to-balloon time is significantly reduced.
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Affiliation(s)
- Leili Yekefallah
- Department of Nursing, Social Determinants of Health Research Center, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mahdi Pournorooz
- Department of Intensive Care Nursing, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Mahmood Alipur
- Department of Biostatistics, Qazvin University of Medical Sciences, Qazvin, Iran
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Borowicz A, Nadolny K, Bujak K, Cieśla D, Gąsior M, Hudzik B. Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction. Cardiol J 2019; 28:110-117. [PMID: 31313273 DOI: 10.5603/cj.a2019.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/03/2019] [Accepted: 06/23/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Time delays to reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) still remain a considerable drawback in many healthcare systems. Emergency medical service (EMS) has a critical role in the early management of STEMI. Under investigation herein, was whether the use of physician-staffed ambulances leads to shorter pre-hospital delays in STEMI patients. METHODS This was an observational and retrospective study, using data from the registry of the Silesian regional EMS system in Katowice, Poland and the Polish Registry on Acute Coronary Syndromes (PL-ACS) for a study period of January 1, 2013 to December 31, 2016. The study population (n = 717) was divided into two groups: group 1 (n = 546 patients) - physician-staffed ambulances and group 2 (n = 171 patients) - paramedic-staffed ambulances. RESULTS Responses during the day and night shifts were similar. Paramedic-led ambulances more often transmitted 12-lead electrocardiogram (ECG) to the percutaneous coronary intervention centers. All EMS time intervals were similar in both groups. The type of EMS dispatched to patients (physicianstaffed vs. paramedic/nurse-only staffed ambulance) was adjusted for ECG transmission, sex had no impact on in-hospital mortality (odds ratio [OR] 1.41; 95% confidence interval [CI] 0.79-1.95; p = 0.4). However, service time exceeding 42 min was an independent predictor of in-hospital mortality (OR 4.19; 95% CI 1.27-13.89; p = 0.019). In-hospital mortality rate was higher in the two upper quartiles of service time in the entire study population. CONCLUSIONS These findings suggest that both physician-led and paramedic-led ambulances meet the criteria set out by the Polish and European authorities. All EMS time intervals are similar regardless of the type of EMS unit dispatched. A physician being present on board did not have a prognostic impact on outcomes.
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Affiliation(s)
- Artur Borowicz
- Voivodeship Rescue Service in Katowice, Katowice, Poland
| | - Klaudiusz Nadolny
- Voivodeship Rescue Service in Katowice, Katowice, Poland.,Department of Emergency Medicine, Medical University of Bialystok, Bialystok.,University of Strategic Planning in Dabrowa Gornicza, Poland
| | - Kamil Bujak
- 3rd Department of Cardiology, Silesian Center for Heart Disease, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Sil
| | - Daniel Cieśla
- Department of Science, Biostatistics and New Technologies, Silesian Center for Heart Disease, Zabrze, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Center for Heart Disease, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Sil
| | - Bartosz Hudzik
- 3rd Department of Cardiology, Silesian Center for Heart Disease, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Sil. .,Department of Cardiovascular Disease Prevention, School of Public Health in Bytom, Medical University of Silesia.
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Brunetti ND, Dell'Anno A, Martone A, Natale E, Rizzon B, Di Cillo O, Russo A. Prehospital ECG transmission results in shorter door-to-wire time for STEMI patients in a remote mountainous region. Am J Emerg Med 2019; 38:252-257. [PMID: 31079977 DOI: 10.1016/j.ajem.2019.04.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pre-hospital triage with ECG-transmission may reduce time to reperfusion in patients with ST-elevation acute myocardial infarction (STEMI). Less, however, is known on potential benefit of ECG-transmission triage in mountain areas, with complex orography. METHODS Patients admitted for STEMI and primary coronary angioplasty (pPCI) in a mountain area served by a single cathlab and triaged with ECG-transmission were enrolled in the study and compared with controls: patients' demographics and time to coronary wire were recorded. RESULTS Forty-seven consecutive patients were enrolled in the study: 23 patients following ECG transmission and 24 STEMI patients who presented directly to the Emergency Department. At multivariable regression analysis, pre-hospital ECG-transmission electrocardiogram was an independent predictor of shorter time-to-wire (beta -0.34, p < 0.05). In case of transport times >30 min, ECG-transmission triage achieved time-to-wire times 20% shorter. Excluding unreducible transport time, avoidable delay was reduced by 38% in the whole population, by 48% in case of peripheral areas (transport time > 30 min from cathlab) and elderly (>80 years) patients (p < 0.05 in all cases). CONCLUSIONS Pre-hospital triage with ECG-transmission is associated with shorter ischemic time even in mountain areas with a complex orography profile. The benefit is greater in elderly patients and remote areas.
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Affiliation(s)
| | | | | | - Emanuela Natale
- Cardiology Department, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy.
| | - Brian Rizzon
- Apulia Regional Telecardiology Service, Policlinico Hospital, Bari, Italy
| | - Ottavio Di Cillo
- Apulia Regional Telecardiology Service, Policlinico Hospital, Bari, Italy
| | - Aldo Russo
- Cardiology Department, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy.
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Kimura K, Kimura T, Ishihara M, Nakagawa Y, Nakao K, Miyauchi K, Sakamoto T, Tsujita K, Hagiwara N, Miyazaki S, Ako J, Arai H, Ishii H, Origuchi H, Shimizu W, Takemura H, Tahara Y, Morino Y, Iino K, Itoh T, Iwanaga Y, Uchida K, Endo H, Kongoji K, Sakamoto K, Shiomi H, Shimohama T, Suzuki A, Takahashi J, Takeuchi I, Tanaka A, Tamura T, Nakashima T, Noguchi T, Fukamachi D, Mizuno T, Yamaguchi J, Yodogawa K, Kosuge M, Kohsaka S, Yoshino H, Yasuda S, Shimokawa H, Hirayama A, Akasaka T, Haze K, Ogawa H, Tsutsui H, Yamazaki T. JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome. Circ J 2019; 83:1085-1196. [DOI: 10.1253/circj.cj-19-0133] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Masaharu Ishihara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital
| | - Katsumi Miyauchi
- Cardiovascular Medicine, Juntendo Tokyo Koto Geriatric Medical Center
| | - Tomohiro Sakamoto
- Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science
| | | | - Shunichi Miyazaki
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hideki Origuchi
- Department of Internal Medicine, Japan Community Health Care Organization Kyushu Hospital
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Kenji Iino
- Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University
| | - Tomonori Itoh
- Department of Medical Education, Iwate Medical University
| | - Yoshitaka Iwanaga
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine
| | - Keiji Uchida
- Division of Cardiovascular Surgery, Yokohama City University Medical Center
| | - Hirohisa Endo
- Department of Cardiovascular Medicine, Juntendo University Hospital
| | - Ken Kongoji
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Hospital
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women’s Medical University
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Hospital
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University Medical Center
| | | | | | - Takahiro Nakashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Gradiate School of Medical and Dental Science
| | | | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Hideaki Yoshino
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Kazuo Haze
- Department of Cardiology, Kashiwara Municipal Hospital
| | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Science, Kyushu University Graduate School of Medical Science
| | - Tsutomu Yamazaki
- Innovation & Research Center, International University of Health and Welfare
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Long B, April MD. In Patients With Acute Myocardial Infarction and No Hypoxemia, Does Oxygen Therapy Improve Outcomes Compared With No Supplemental Oxygen? Ann Emerg Med 2019; 73:403-405. [DOI: 10.1016/j.annemergmed.2018.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Indexed: 10/16/2022]
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Meloni L, Floris R, Congia M, Cacace C, Marchetti MF, Contu P, Montisci R. The difficult task of reducing symptom onset-to-balloon time among patients undergoing primary PCI. J Cardiovasc Med (Hagerstown) 2019; 20:363-365. [PMID: 30921271 DOI: 10.2459/jcm.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Luigi Meloni
- Clinical Cardiology, Department of Medical Sciences and Public Health, University of Cagliari, Italy
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Hof D, von Eckardstein A. High-Sensitivity Troponin Assays in Clinical Diagnostics of Acute Coronary Syndrome. Methods Mol Biol 2019; 1929:645-662. [PMID: 30710302 DOI: 10.1007/978-1-4939-9030-6_40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Nowadays, measurement of cardiac troponins (cTn) in patient plasma is central for diagnosis of patients with acute coronary syndrome (ACS). High-sensitivity (hs) immunoassays have been developed that can very precisely record slightly elevated and rising plasma concentrations of cTn very early after onset of clinical symptoms. Algorithms integrate measurements of hs-cTn at onset of clinical symptoms of acute myocardial infarction (AMI), and 1 or 3 h after onset, to rule-in and rule-out AMI patients. More and more point-of-care (POC) cTn assays conquer the diagnostic market, but thorough clinical validation studies are required before potential implementation of such POC tests into hospital settings. This review provides an overview of the technical aspects, as well as diagnostic and prognostic use of cardiac troponins in AMI patients and in the healthy population.
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Papai G, Csato G, Racz I, Szabo G, Barany T, Racz A, Szokol M, Sarman B, Edes IF, Czuriga D, Kolozsvari R, Edes I. The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. J Telemed Telecare 2018; 26:216-222. [PMID: 30526257 PMCID: PMC7222284 DOI: 10.1177/1357633x18814335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The transtelephonic electrocardiogram has been shown to have a great value in the management of out-of-hospital chest pain emergencies. In our previous study it not only improved the pre-hospital medical therapy and time to intervention, but also the in-hospital mortality in ST-segment elevation myocardial infarction. It was hypothesised that the higher in-hospital survival rate could be due to improved transtelephonic electrocardiogram-based pre-hospital management (electrocardiogram interpretation and teleconsultation) and consequently, better coronary perfusion of patients at the time of hospital admission. To test this hypothesis, our database of ST-segment elevation myocardial infarction patients was evaluated retrospectively for predictors (including transtelephonic electrocardiogram) that may influence in-hospital survival. METHODS AND RESULTS The ST-segment elevation myocardial infarction patients were divided into two groups, namely (a) hospital death patients (n = 49) and (b) hospital survivors (control, n = 726). Regarding pre-hospital medical management, the transtelephonic electrocardiogram-based triage (odds ratio 0.48, confidence interval 0.25-0.92, p = 0.0261) and the administration of optimal pre-hospital medical therapy (acetylsalicylic acid and/or clopidogrel and glycoprotein IIb/IIIa inhibitor) were the most important independent predictors for a decreased risk in our model. At the same time, age, acute heart failure (Killip class >2), successful pre-hospital resuscitation and total occlusion of the infarct-related coronary artery before percutaneous coronary intervention were the most important independent predictors for an increased risk of in-hospital mortality. DISCUSSION In ST-segment elevation myocardial infarction patients, (a) an early transtelephonic electrocardiogram-based teleconsultation and triage, (b) optimal pre-hospital antithrombotic medical therapy and (c) the patency and better perfusion of the infarct-related coronary artery on hospital admission are important predictors of a lower in-hospital mortality rate.
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Affiliation(s)
| | - Gabor Csato
- Hungarian National Ambulance Service, Hungary
| | - Ildiko Racz
- Division of Cardiology, University of Debrecen, Hungary
| | - Gabor Szabo
- Division of Cardiology, University of Debrecen, Hungary
| | - Tamas Barany
- Division of Cardiology, University of Debrecen, Hungary
| | - Agnes Racz
- Division of Cardiology, University of Debrecen, Hungary
| | - Miklos Szokol
- Division of Cardiology, University of Debrecen, Hungary
| | | | - Istvan F Edes
- Heart and Vascular Center, Semmelweis University, Hungary
| | | | | | - Istvan Edes
- Division of Cardiology, University of Debrecen, Hungary
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Mehta S, Vega R, Bojanini F, Corral J, Bulla Á, Botelho R, Fernández F, Rodríguez D, Torres MA, Cortizo Vidal LL. Manejo ejemplar del infarto agudo de miocardio con la utilización de protocolos sofisticados de Telemedicina. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abuzaid A, Fabrizio C, Felpel K, Al Ashry HS, Ranjan P, Elbadawi A, Mohamed AH, Barssoum K, Elgendy IY. Oxygen Therapy in Patients with Acute Myocardial Infarction: A Systemic Review and Meta-Analysis. Am J Med 2018; 131:693-701. [PMID: 29355510 DOI: 10.1016/j.amjmed.2017.12.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Oxygen therapy is frequently used for patients with acute myocardial infarction. The aim of this study is to perform a systematic review and meta-analysis to compare the outcomes of oxygen therapy versus no oxygen therapy in post-acute myocardial infarction settings. METHODS A systematic search of electronic databases was conducted for randomized studies, which reported cardiovascular events in oxygen versus no oxygen therapy. The evaluated outcomes were all-cause mortality, recurrent coronary events (ischemia or myocardial infarction), heart failure, and arrhythmias. Summary-adjusted risk ratios (RRs) were calculated by the random effects DerSimonian and Laird model. The risk of bias of the included studies was assessed by Cochrane scale. RESULTS Our meta-analysis included a total of 7 studies with 3842 patients who received oxygen therapy and 3860 patients without oxygen therapy. Oxygen therapy did not decrease the risk of all-cause mortality (pooled RR, 0.99; 95% confidence interval [CI], 0.81-1.21; P = .43), recurrent ischemia or myocardial infarction (pooled RR, 1.19; 95% CI, 0.95-1.48; P = .75), heart failure (pooled RR, 0.94; 95% CI, 0.61-1.45; P = .348), and occurrence of arrhythmia events (pooled RR, 1.01; 95% CI, 0.85-1.2; P = .233) compared with the no oxygen arm. CONCLUSIONS This meta-analysis confirms the lack of benefit of routine oxygen therapy in patients with acute myocardial infarction with normal oxygen saturation levels.
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Affiliation(s)
- Ahmed Abuzaid
- Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, Del.
| | - Carly Fabrizio
- Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, Del
| | - Kevin Felpel
- Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, Del
| | - Haitham S Al Ashry
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston
| | - Pragya Ranjan
- Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, Del
| | - Ayman Elbadawi
- Department of Medicine, Rochester General Hospital, Rochester, NY
| | - Ahmed H Mohamed
- Department of Medicine, Rochester General Hospital, Rochester, NY
| | - Kirolos Barssoum
- Department of Medicine, Rochester General Hospital, Rochester, NY
| | - Islam Y Elgendy
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville
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Nakashima T, Tahara Y. Achieving the earliest possible reperfusion in patients with acute coronary syndrome: a current overview. J Intensive Care 2018; 6:20. [PMID: 29568528 PMCID: PMC5856388 DOI: 10.1186/s40560-018-0285-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/21/2018] [Indexed: 01/26/2023] Open
Abstract
Acute coronary syndrome (ACS) remains one of the leading causes of mortality worldwide. Appropriate management of ACS will lead to a lower incidence of cardiac arrest. Percutaneous coronary intervention (PCI) is the first-line treatment for patients with ACS. PCI techniques have become established. Thus, the establishment of a system of health care in the prehospital and emergency department settings is needed to reduce mortality in patients with ACS. In this review, evidence on how to achieve earlier diagnosis, therapeutic intervention, and decision to reperfuse with a focus on the prehospital and emergency department settings is systematically summarized. The purpose of this review is to generate current, evidence-based consensus on scientific and treatment recommendations for health care providers who are the initial points of contact for patients with signs and symptoms suggestive of ACS.
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Affiliation(s)
- Takahiro Nakashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, 565-8565 Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, 565-8565 Japan
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Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. [2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.]. Eur Heart J 2018; 39:119-177. [PMID: 29457615 DOI: 10.1093/eurheartj/ehx393] [Citation(s) in RCA: 6211] [Impact Index Per Article: 1035.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Borja Ibanez
- Department of Cardiology, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
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Hsia RY, Sabbagh S, Sarkar N, Sporer K, Rokos IC, Brown JF, Brindis RG, Guo J, Shen YC. Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction. West J Emerg Med 2017; 18:1010-1017. [PMID: 29085531 PMCID: PMC5654868 DOI: 10.5811/westjem.2017.8.34592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/12/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction California has led successful regionalized efforts for several time-critical medical conditions, including ST-segment elevation myocardial infarction (STEMI), but no specific mandated protocols exist to define regionalization of care. We aimed to study the trends in regionalization of care for STEMI patients in the state of California and to examine the differences in patient demographic, hospital, and county trends. Methods Using survey responses collected from all California emergency medical services (EMS) agencies, we developed four categories – no, partial, substantial, and complete regionalization – to capture prehospital and inter-hospital components of regionalization in each EMS agency’s jurisdiction between 2005–2014. We linked the survey responses to 2006 California non-public hospital discharge data to study the patient distribution at baseline. Results STEMI regionalization-of-care networks steadily developed across California. Only 14% of counties were regionalized in 2006, accounting for 42% of California’s STEMI patient population, but over half of these counties, representing 86% of California’s STEMI patient population, reached complete regionalization in 2014. We did not find any dramatic differences in underlying patient characteristics based on regionalization status; however, differences in hospital characteristics were relatively substantial. Conclusion Potential barriers to achieving regionalization included competition, hospital ownership, population density, and financial challenges. Minimal differences in patient characteristics can establish that patient differences unlikely played any role in influencing earlier or later regionalization and can provide a framework for future analyses evaluating the impact of regionalization on patient outcomes.
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Affiliation(s)
- Renee Y Hsia
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.,University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, California
| | - Sarah Sabbagh
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Nandita Sarkar
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Karl Sporer
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.,Alameda County Emergency Medical Services Agency, Oakland, California
| | - Ivan C Rokos
- University of California, Los Angeles-Olive View Medical Center; Geffen School of Medicine, Los Angeles, California
| | - John F Brown
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.,San Francisco Emergency Medical Services Agency, San Francisco, California
| | - Ralph G Brindis
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, California.,University of California, San Francisco, Department of Medicine, San Francisco, California
| | - Joanna Guo
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Yu-Chu Shen
- National Bureau of Economic Research, Cambridge, Massachusetts.,Naval Postgraduate School, Graduate School of Business and Public Policy, Monterey, California
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Fordyce CB, Henry TD, Granger CB. Implementation of Regional ST-Segment Elevation Myocardial Infarction Systems of Care: Successes and Challenges. Interv Cardiol Clin 2017; 5:415-425. [PMID: 28581992 DOI: 10.1016/j.iccl.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Current guidelines recommend that communities create and maintain a regional system of ST-segment elevation myocardial infarction (STEMI) care that includes assessment and continuous quality improvement of emergency medical services and hospital-based activities. Availability and timely access is a challenge in many areas of the United States. This article reviews clinical trial data supporting the use of primary percutaneous coronary intervention as the optimal reperfusion strategy, and fibrinolysis as an option when this is not possible. It then describes the outcomes and benefits of implementing regional systems of STEMI care, and discusses ongoing challenges for STEMI system implementation, including inadequate data collection and feedback, and hospital and physician competition.
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Affiliation(s)
| | - Timothy D Henry
- Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Suite A3100, Los Angeles, CA 90048, USA
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Caldarola P, Gulizia MM, Gabrielli D, Sicuro M, De Gennaro L, Giammaria M, Grieco NB, Grosseto D, Mantovan R, Mazzanti M, Menotti A, Brunetti ND, Severi S, Russo G, Gensini GF. ANMCO/SIT Consensus Document: telemedicine for cardiovascular emergency networks. Eur Heart J Suppl 2017; 19:D229-D243. [PMID: 28751844 PMCID: PMC5520753 DOI: 10.1093/eurheartj/sux028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Telemedicine has deeply innovated the field of emergency cardiology, particularly the treatment of acute myocardial infarction. The ability to record an ECG in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. This consensus document aims to analyse the available evidence and organizational models based on a support by telemedicine, focusing on technical requirements, education, and legal aspects.
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Affiliation(s)
- Pasquale Caldarola
- Cardiology Department, San Paolo Hospital, Via Caposcardicchio, 70123 Bari, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Garibal-Nesima Hospital, Ospedale Nesima-Garibaldi, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| | | | - Marco Sicuro
- Cardiology and Cardiac Intensive Care, Regionale Umberto Parini Hospital, Aosta, Italy
| | - Luisa De Gennaro
- Cardiology Department, San Paolo Hospital, Via Caposcardicchio, 70123 Bari, Italy
| | | | | | | | - Roberto Mantovan
- Cardiology Unit, Ospedale Santa Maria dei Battuti, Conegliano (Treviso), Italy
| | - Marco Mazzanti
- Cardiology Hemodynamics-CCU Department, University "Ospedali Riuniti" Hospital, Ancona, Italy
| | | | | | - Silva Severi
- Cardiology Unit, Misericordia Hospital, Grosseto, Italy
| | - Giancarmine Russo
- Italian Society for Telemedicine and eHealth (Digital SIT), Rome, Italy
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Zhao X, Yang X, Gao C, Chu Y, Yang L, Tian L, Li L. Improved Survival of Patients with ST-Segment Elevation Myocardial Infarction 3-6 Hours After Symptom Onset Is Associated with Inter-Hospital Transfer for Primary Percutaneous Coronary Intervention (PCI) at a Large Regional ST-Segment Elevation Myocardial Infarction (STEMI) Program vs. In-Hospital Thrombolysis in a Community Hospital. Med Sci Monit 2017; 23:1055-1063. [PMID: 28240997 PMCID: PMC5341906 DOI: 10.12659/msm.902466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND This study sought to compare the 30-day and 1-year survival of patients diagnosed with ST-segment elevation myocardial infarction (STEMI), whose symptom onset to in-hospital first medical contact (IHFMC) was 3-6 h, who received either in-hospital thrombolysis (IHT) in the nearest county hospital or direct transfer to a larger hospital in Henan province, China for primary percutaneous coronary intervention (PPCI). MATERIAL AND METHODS Patients were allocated into 2 groups: one group received IHT in the local county hospital, whereas the other group were transferred to the PCI centers to receive PPCI. Patient demographic data, baseline characteristics, and time between different stages of patient contact to the initiation of treatment for IHT or PPCI were recorded for analysis. RESULTS No significant difference was identified between the 2 groups with the baseline characteristics and demographic data. The all-cause mortality was not significantly different between the IHT and PPCI group at 30 days (13.0% vs. 9.9%, p=0.386). However, a significant difference in mortality between the IHT and PPCI group was observed at 1 year (23.4% vs. 14.1%, p=0.035). Inter-hospital transfer time for PPCI tended to be the independent predictor for survival (OR: 4.4 CI 95%: 1.9-14.5, p 0.001). Overall, the patients undergoing PPCI in inter-hospital transfer had a higher survival rates for 1 year compared with patients receiving IHT. CONCLUSIONS Despite the delay associated with inter-hospital transfer for PPCI, patients with STEMI 3-6 h after symptom onset have improved survival with PPCI over patients treated locally with IHT.
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Affiliation(s)
- Xiangmei Zhao
- Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland)
| | - Xianzhi Yang
- Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland)
| | - Chuanyu Gao
- Deparment of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland)
| | - Yingjie Chu
- Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland)
| | - Lei Yang
- Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland)
| | - Lixiao Tian
- Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland)
| | - Lin Li
- Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland)
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Molinari G, Molinari M, Di Biase M, Brunetti ND. Telecardiology and its settings of application: An update. J Telemed Telecare 2017; 24:373-381. [PMID: 28084886 DOI: 10.1177/1357633x16689432] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Among the wide range of medical specialties in which telemedicine has been successfully applied, cardiology can be considered as one of the most important fields of application. Through the transmission of clinical data and the electrocardiogram, telecardiology allows access to a real-time assessment (teleconsultation) without any need to travel for both patient and cardiologist. This review discusses the impact of telecardiology in different clinical settings of application. Pre-hospital telecardiology has proved to be useful either in the clinical management of remote patients with acute coronary syndrome or in supporting the decision-making process of general practitioners. In the setting of in-hospital telecardiology, most of the applications refer to real-time echocardiography transmissions between rural small hospitals and tertiary care centres, particularly for the diagnosis or exclusion of congenital heart disease in newborns. Finally, many trials show that post-hospital telecardiology improves outcomes and reduces re-admissions or outpatient contacts in patients with heart failure, arrhythmias or implantable devices.
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Affiliation(s)
| | | | - Matteo Di Biase
- 2 Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Natale D Brunetti
- 2 Department of Medical and Surgical Sciences, University of Foggia, Italy
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Brunetti ND, De Gennaro L, Correale M, Santoro F, Caldarola P, Gaglione A, Di Biase M. Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: A meta-analysis and meta-regression analysis of non-randomized studies. Int J Cardiol 2017; 232:5-11. [PMID: 28089154 DOI: 10.1016/j.ijcard.2017.01.055] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND A shorter time to treatment has been shown to be associated with lower mortality rates in acute myocardial infarction (AMI). Several strategies have been adopted with the aim to reduce any delay in diagnosis of AMI: pre-hospital triage with telemedicine is one of such strategies. We therefore aimed to measure the real effect of pre-hospital triage with telemedicine in case of AMI in a meta-analysis study. METHODS We performed a meta-analysis of non-randomized studies with the aim to quantify the exact reduction of time to treatment achieved by pre-hospital triage with telemedicine. Data were pooled and compared by relative time reduction and 95% C.I.s. A meta-regression analysis was performed in order to find possible predictors of shorter time to treatment. RESULTS Eleven studies were selected and finally evaluated in the study. The overall relative reduction of time to treatment with pre-hospital triage and telemedicine was -38/-40% (p<0.001). Absolute time reduction was significantly correlated to time to treatment in the control groups (p<0.001), while relative time reduction was independent. A non-significant trend toward shorter relative time reductions was observed over years. CONCLUSIONS Pre-hospital triage with telemedicine is associated with a near halved time to treatment in AMI. The benefit is larger in terms of absolute time to treatment reduction in populations with larger delays to treatment.
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Affiliation(s)
| | | | | | - Francesco Santoro
- Asklepios Klinik Sankt Georg, Hamburg, Germany; Department of Medical & Surgical Sciences, University of Foggia, Italy
| | | | - Antonio Gaglione
- Department of Medical & Surgical Sciences, University of Foggia, Italy
| | - Matteo Di Biase
- Department of Medical & Surgical Sciences, University of Foggia, Italy
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Fordyce CB, Cairns JA, Singer J, Lee T, Park JE, Vandegriend RA, Perry M, Largy W, Gao M, Ramanathan K, Wong GC. Evolution and Impact of a Regional Reperfusion System for ST-Elevation Myocardial Infarction. Can J Cardiol 2016; 32:1222-1230. [DOI: 10.1016/j.cjca.2015.11.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/22/2015] [Accepted: 11/24/2015] [Indexed: 10/24/2022] Open
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Bata A, Quraishi AUR, Love M, Title L, Beydoun H, Lee T, Nadeem N, Kidwai B, Kells C, Curran H. Initial experience with pre-activation of the cardiac catheterization lab and emergency room bypass for patients with ST-elevation myocardial infarction in Halifax, Nova Scotia. Int J Cardiol 2016; 222:645-647. [PMID: 27517655 DOI: 10.1016/j.ijcard.2016.07.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/27/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND To determine whether pre-activation of the cardiac catheterization lab by Emergency Health Services (EHS) with a single call system in the field was associated with reduced time to reperfusion in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS Consecutive STEMI patients identified by EHS and subsequently taken to the Queen Elizabeth II Health Sciences Center (QEIIHSC) for PPCI between February 1, 2011 and January 30, 2013 were examined. Patients who had pre-activation of the catheterization lab from the field (pre-act group) after the acquisition of the LifeNet® system (Physio Control, Redmond Washington) were compared to those who had usual activation (routine group) prior to the acquisition of the LifeNet® system, for outcomes including treatment timeline data and mortality. RESULTS 271 patients were included in the analysis, 149 patients in the pre-act group and 122 patients in the routine group. Door-to-device (DTD) times of less than 90min were achieved more frequently in the Pre-act group (91.9% vs. 62.2%; P<0.001). DTD time was shorter in the Pre-act group (48min IQR: 38 to 63min vs. 78min IQR: 64-101min; p=0.001) as was first medical contact-to-device (FMCTD) time (91min IQR: 78 to 106min vs. 115min IQR: 90 to 139min; P<0.001). False activation of the catheterization lab was infrequent (1.3%). CONCLUSIONS Implementation of catheterization lab pre-activation using the LifeNet® system was associated with more efficient reperfusion times as measured by reduced FMCTD and DTD times without excess false activation rates.
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Affiliation(s)
- Adil Bata
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, 1796 Summer Street, Halifax Infirmary, 2nd Floor, Halifax, Nova Scotia B3H 3A7, Canada
| | - Ata Ur Rehman Quraishi
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, 1796 Summer Street, Halifax Infirmary, 2nd Floor, Halifax, Nova Scotia B3H 3A7, Canada
| | - Michael Love
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, 1796 Summer Street, Halifax Infirmary, 2nd Floor, Halifax, Nova Scotia B3H 3A7, Canada
| | - Lawrence Title
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, 1796 Summer Street, Halifax Infirmary, 2nd Floor, Halifax, Nova Scotia B3H 3A7, Canada
| | - Hussein Beydoun
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, 1796 Summer Street, Halifax Infirmary, 2nd Floor, Halifax, Nova Scotia B3H 3A7, Canada
| | - Tony Lee
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, 1796 Summer Street, Halifax Infirmary, 2nd Floor, Halifax, Nova Scotia B3H 3A7, Canada
| | - Najaf Nadeem
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, 1796 Summer Street, Halifax Infirmary, 2nd Floor, Halifax, Nova Scotia B3H 3A7, Canada
| | - Bakhtiar Kidwai
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, 1796 Summer Street, Halifax Infirmary, 2nd Floor, Halifax, Nova Scotia B3H 3A7, Canada
| | - Catherine Kells
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, 1796 Summer Street, Halifax Infirmary, 2nd Floor, Halifax, Nova Scotia B3H 3A7, Canada
| | - Helen Curran
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, 1796 Summer Street, Halifax Infirmary, 2nd Floor, Halifax, Nova Scotia B3H 3A7, Canada.
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Nakatsuma K, Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Yamamoto T, Suwa S, Horie M, Kimura T. Inter-Facility Transfer vs. Direct Admission of Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Circ J 2016; 80:1764-72. [PMID: 27350014 DOI: 10.1253/circj.cj-16-0204] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inter-facility transfer for primary percutaneous coronary intervention (PCI) from referring facilities to PCI centers causes a significant delay in treatment of ST-segment elevation acute myocardial infarction (STEMI) patients undergoing primary PCI. However, little is known about the clinical outcomes of STEMI patients undergoing inter-facility transfer in Japan. METHODS AND RESULTS In the CREDO-Kyoto acute myocardial infarction (AMI) registry that enrolled 5,429 consecutive AMI patients in 26 centers in Japan, the current study population consisted of 3,820 STEMI patients who underwent primary PCI within 24 h of symptom onset. We compared long-term clinical outcomes between inter-facility transfer patients and those directly admitted to PCI centers. The primary outcome measure was a composite of all-cause death or heart failure (HF) hospitalization. There were 1,725 (45.2%) inter-facility transfer patients, and 2,095 patients (54.8%) with direct admission to PCI centers. The cumulative 5-year incidence of death/HF hospitalization was significantly higher in the inter-facility transfer patients than in those with direct admission (26.9% vs. 22.2%; log-rank P<0.001). After adjusting for potential confounders, the risk for death/HF hospitalization was significantly higher (adjusted hazard ratio: 1.22, 95% confidence interval: 1.07-1.40, P<0.001) in the inter-facility transfer patients than in those directly admitted. CONCLUSIONS Inter-facility transfer was associated with significantly worse long-term clinical outcomes for patients with STEMI undergoing primary PCI. (Circ J 2016; 80: 1764-1772).
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Affiliation(s)
- Kenji Nakatsuma
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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Abstract
Cardiovascular disease is one of the main fields of application for telemedicine, with benefits in almost all areas in the continuum of cardiovascular disease. The greatest impact has been shown in the early diagnosis of cardiovascular disease, in second consultation, between non-cardiologist and cardiologist and between cardiologists, and in follow-up and secondary prevention of cardiovascular disease. At present, the main area of implementation for telemedicine in cardiovascular disease is represented by pre-hospital triage, with telemedicine electrocardiogram in acute myocardial infarction. Significant results have also been achieved in the second opinion consultation of pediatric subjects with congenital cardiovascular disease, home-monitoring and the management of patients affected by chronic heart failure or with an implanted device. However, there is significant room for further improvement in delivering telemedicine assistance even in 'very-remote' populations, such as detainees, patients in developing countries or in underdeveloped areas of developed countries.
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Affiliation(s)
| | - Simonetta Scalvini
- b U.O. Cardiologia Riabilitativa , IRCCS Fondazione Salvatore Maugeri , Brescia , Italy
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Callachan EL, Alsheikh-Ali AA, Bruijns S, Wallis LA. Physician perceptions and recommendations about pre-hospital emergency medical services for patients with ST-elevation acute myocardial infarction in Abu Dhabi. J Saudi Heart Assoc 2016; 28:7-14. [PMID: 26778900 PMCID: PMC4685199 DOI: 10.1016/j.jsha.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Physician perceptions about emergency medical services (EMS) are important determinants of improving pre-hospital care for cardiac emergencies. No data exist on physician attitudes towards EMS care of patients with ST-Elevation Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi. Objectives To describe the perceptions towards EMS among physicians caring for patients with STEMI in Abu Dhabi. Methods We surveyed a convenience sample of physicians involved in the care of patients with STEMI (emergency medicine, cardiology, cardiothoracic surgery and intensive care) in four government facilities with 24/7 Primary PCI in the Emirate of Abu Dhabi. Surveys were distributed using dedicated email links, and used 5-point Likert scales to assess perceptions and attitudes to EMS. Results Of 106 physician respondents, most were male (82%), practicing in emergency medicine (47%) or cardiology (44%) and the majority (63%) had been in practice for >10 years. Less than half of the responders (42%) were “Somewhat Satisfied” (35%) or “Very Satisfied” (7%) with current EMS level of care for STEMI patients. Most respondents were “Very Likely” (67%) to advise a patient with a cardiac emergency to use EMS, but only 39% felt the same for themselves or their family. Most responders were supportive (i.e. “Strongly Agree”) of the following steps to improve EMS care: 12-lead ECG and telemetry to ED by EMS (69%), EMS triage of STEMI to PCI facilities (65%), and activation of PCI teams by EMS (58%). Only 19% were supportive of pre-hospital fibrinolytics by EMS. There were no significant differences in the responses among the specialties. Conclusions Most physicians involved in STEMI care in Abu Dhabi are very likely to advise patients to use EMS for a cardiac emergency, but less likely to do so for themselves or their families. Different specialties had concordant opinions regarding steps to improve pre-hospital EMS care for STEMI.
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Affiliation(s)
- Edward L Callachan
- University of Cape Town, Division of Emergency Medicine, Private Bag X24, Belleville 7535, South Africa
| | - Alawi A Alsheikh-Ali
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, P.O. Box 59100, Abu Dhabi, United Arab Emirates; Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, MA, USA
| | - Stevan Bruijns
- University of Cape Town, Division of Emergency Medicine, Private Bag X24, Belleville 7535, South Africa
| | - Lee A Wallis
- University of Cape Town, Division of Emergency Medicine, Private Bag X24, Belleville 7535, South Africa
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Soo Hoo SY, Gallagher R, Elliott D. Field triage to primary percutaneous coronary intervention: Factors influencing health-related quality of life for patients aged ≥70 and <70 years with non-complicated ST-elevation myocardial infarction. Heart Lung 2015; 45:56-63. [PMID: 26651599 DOI: 10.1016/j.hrtlng.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 10/15/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine clinical and health-related quality of life (HRQOL) outcomes and predictors of HRQOL for uncomplicated field triage ST-elevation myocardial infarction (STEMI) patients aged ≥70 years and <70 years after primary percutaneous coronary intervention (PPCI). BACKGROUND Pre-hospital field triage for PPCI is associated with lower mortality but the impact of age and other factors on HRQOL remains unknown. METHODS 77 field triage STEMI patients were assessed for HRQOL using the Short Form-12 (SF-12) and the Seattle Angina Questionnaire (SAQ) at 4 weeks and 6 months after PPCI. RESULTS Regression analysis showed improvements in SF-12 domains and angina stability for older people. Age predicted lower physical function (p = 0.001) and better SAQ QOL at 6 months (p = 0.003). CONCLUSION Age, length of hospitalization, recurrent angina and hypertension were important predictors of HRQOL with PPCI. Assessment of HRQOL combined with increased support for physical and emotional recovery is needed to improve clinical care for field triage PPCI patients.
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Affiliation(s)
- Soon Yeng Soo Hoo
- Royal North Shore Hospital, Department of Cardiology, Sydney, Australia; University of Technology Sydney, Faculty of Health, Sydney, Australia.
| | - Robyn Gallagher
- University of Sydney, Charles Perkins Centre, Sydney Nursing School, Sydney, Australia
| | - Doug Elliott
- University of Technology Sydney, Faculty of Health, Sydney, Australia
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Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Nikolaou N, Arntz H, Bellou A, Beygui F, Bossaert L, Cariou A. Das initiale Management des akuten Koronarsyndroms. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0084-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Brunetti ND, Tarantino N, Dellegrottaglie G, Abatecola G, De Gennaro L, Bruno AI, Bux F, Gaglione A, Di Biase M. Impact of telemedicine support by remote pre-hospital electrocardiogram on emergency medical service management of subjects with suspected acute cardiovascular disease. Int J Cardiol 2015. [DOI: 10.1016/j.ijcard.2015.06.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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