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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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Lapostolle F, Petrovic T, Moiteaux B, Loyeau A, Boche T, Kadji Kalabang R, Le Bail G, Lamhaut L, Lafay M, Dupas F, Scannavino M, Benamer H, Bataille S, Lambert Y. Evolution of REperfusion Strategies and impact on mortality in Old and Very OLD STEMI patients. The RESOVOLD-e-MUST study. Age Ageing 2024; 53:afad215. [PMID: 38167925 PMCID: PMC10762506 DOI: 10.1093/ageing/afad215] [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] [Received: 01/31/2022] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The use of myocardial reperfusion-mainly via angioplasty-has increased in our region to over 95%. We wondered whether old and very old patients have benefited from this development. METHODS Setting: Greater Paris Area (Ile-de-France). DATA Regional registry, prospective, including since 2003, data from 39 mobile intensive care units performing prehospital treatment of patients with ST segment elevation myocardial infarction (STEMI) (<24 h). PARAMETERS Demographic, decision to perform reperfusion and outcome (in-hospital mortality). PRIMARY ENDPOINT Reperfusion decision rate by decade over age 70. SECONDARY ENDPOINT Outcome. RESULTS We analysed the prehospital management of 27,294 patients. There were 21,311 (78%) men and 5,919 (22%) women with a median age of 61 (52-73 years). Among these patients, 8,138 (30%) were > 70 years, 3,784 (14%) > 80 years and 672 (2%) > 90 years.The reperfusion decision rate was 94%. It decreased significantly with age: 93, 90 and 76% in patients in their seventh, eighth and ninth decade, respectively. The reperfusion decision rate increased significantly over time. It increased in all age groups, especially the higher ones. Mortality was 6%. It increased significantly with age: 8, 16 and 25% in patients in their seventh, eighth and ninth decade, respectively. It significantly decreased over time in all age groups. The odds ratio of the impact of reperfusion decision on mortality reached 0.42 (0.26-0.68) in patients over 90 years. CONCLUSION the increase in the reperfusion decision rate was the greatest in the oldest patients. It reduced mortality even in patients over 90 years of age.
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Affiliation(s)
- Frédéric Lapostolle
- SAMU 93, UF Recherche-Enseignement-Qualité, Avicenne Hospital-APHP, Bobigny, France
- Université Paris 13, INSERM Unit 942, Sorbonne Paris Cité, Bobigny, France
| | - Tomislav Petrovic
- SAMU 93, UF Recherche-Enseignement-Qualité, Avicenne Hospital-APHP, Bobigny, France
- Université Paris 13, INSERM Unit 942, Sorbonne Paris Cité, Bobigny, France
| | | | | | - Thévy Boche
- SAMU 94, Mondor Hospital-APHP, Créteil, France
| | | | | | | | - Marina Lafay
- SAMU 91, Sud Francilien Hospital, Corbeil-Essonnes, France
| | | | | | - Hakim Benamer
- Cardiology Department, Institut Cardiovasculaire Paris Sud (ICPS), Massy, France
| | | | - Yves Lambert
- SAMU 78, Versailles Hospital, Le Chesnay, France
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Lapostolle F, Loyeau A, Bataille S, Moiteaux B, Lambert Y. [e-MUST Registry - Evaluation of prehospital medical management of STEMI in Île-de-France]. Ann Cardiol Angeiol (Paris) 2023; 72:101687. [PMID: 37948923 DOI: 10.1016/j.ancard.2023.101687] [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] [Received: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
The e-MUST registry has continuously and comprehensively documented ST-segment elevation myocardial infarctions (STEMIs) managed in the prehospital setting by the 39 Mobile Emergency and Resuscitation Services (SMUR) of the 8 Emergency Medical Assistance System (SAMU) and subsequently managed in the 36 interventional cardiology services in Île-de-France since 2000. This encompasses a population of over 12 million residents. To date, nearly 44,000 patients have been enrolled. The analysis of these findings reflects the real-world management of these patients and the evolution of their care. The results are shared annually with the investigators' teams and have led to around twenty publications. The latest acquired results have demonstrated, in a series of over 630 patients aged over 90, that nonagenarians particularly benefit from prehospital coronary reperfusion decisions, resulting in a nearly 60% reduction in mortality.
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Affiliation(s)
- Frédéric Lapostolle
- SAMU 93, UF Recherche-Enseignement-Qualité, Hôpital Avicenne, Bobigny, Université Paris 13, France.
| | - Aurélie Loyeau
- SAMU 93, UF Recherche-Enseignement-Qualité, Hôpital Avicenne, Bobigny, Université Paris 13, France
| | - Sophie Bataille
- Département de l'offre de soins, Agence Régionale de Santé d'Île-de-France, Paris, France
| | - Brice Moiteaux
- Département Traitement de l'information, GIP SESAN, Paris , France
| | - Yves Lambert
- SAMU 78, Centre Hospitalier de Versailles, Le Chesnay, France
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Nassetta LB, Marlin B, Scalici P. Clinical guideline highlights for the hospitalist: Pediatric direct hospital admission. J Hosp Med 2023; 18:1120-1122. [PMID: 37731201 DOI: 10.1002/jhm.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/22/2023]
Abstract
GUIDELINE TITLE Direct Admission to the Hospital for Children in the United States RELEASE DATE: March 3, 2023 PRIOR VERSION(S): n/a DEVELOPER: American Academy of Pediatrics, Committee on Hospital Care FUNDING SOURCE: American Academy of Pediatrics TARGET POPULATION: Children who are potential candidates for direct hospital admission.
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Affiliation(s)
- Lauren B Nassetta
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brittany Marlin
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Scalici
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 533] [Impact Index Per Article: 533.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Baugh CW, Freund Y, Steg PG, Body R, Maron DJ, Yiadom MYAB. Strategies to mitigate emergency department crowding and its impact on cardiovascular patients. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:633-643. [PMID: 37163667 DOI: 10.1093/ehjacc/zuad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023]
Abstract
Emergency department (ED) crowding is a worsening global problem caused by hospital capacity and other health system challenges. While patients across a broad spectrum of illnesses may be affected by crowding in the ED, patients with cardiovascular emergencies-such as acute coronary syndrome, malignant arrhythmias, pulmonary embolism, acute aortic syndrome, and cardiac tamponade-are particularly vulnerable. Because of crowding, patients with dangerous and time-sensitive conditions may either avoid the ED due to anticipation of extended waits, leave before their treatment is completed, or experience delays in receiving care. In this educational paper, we present the underlying causes of crowding and its impact on common cardiovascular emergencies using the input-throughput-output process framework for patient flow. In addition, we review current solutions and potential innovations to mitigate the negative effect of ED crowding on patient outcomes.
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Affiliation(s)
- Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Neville House 2nd Floor, Boston, MA 02115, USA
| | - Yonathan Freund
- Emergency Department Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Philippe Gabriel Steg
- Department of Cardiology, Université Paris-Cité, Institut Universitaire de France, FACT, French Alliance for Cardiovascular Trials, INSERM-1148, and Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Richard Body
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
- Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Leyenaar JK, Hill V, Lam V, Stern R, Vaughan KW. Direct Admission to Hospital for Children in the United States. Pediatrics 2023; 151:e2022060973. [PMID: 36843482 PMCID: PMC10578325 DOI: 10.1542/peds.2022-060973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
One in four unscheduled hospital admissions for children and adolescents in the United States occurs via direct admission, defined as hospital admission without first receiving care in the hospital's emergency department. The purpose of this policy statement is to present recommendations to optimize the quality and safety of this hospital admission approach for children. Recommendations included in this policy statement provide guidance related to: (i) direct admission written guidelines, (ii) clear systems of communication between members of the health care team and with families of children requiring admission, (iii) triage systems to identify patient acuity and disease severity, (iv) identification of hospital resources needed to support direct admission systems of care, (v) consideration of patient populations that may be at increased risk of adverse outcomes during the hospital admission process, (vi) addressing the relevance of local factors and resources, and (vii) ongoing evaluation of direct admission processes and outcomes. The recommendations included in this policy statement are intended to support the implementation of safe direct admission processes and to foster awareness of outcomes associated with this common portal of hospital admission.
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Affiliation(s)
- JoAnna K. Leyenaar
- Department of Pediatrics and The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Vanessa Hill
- Department of Pediatrics, Baylor College of Medicine, Children’s Hospital of San Antonio, San Antonio, Texas
| | - Vinh Lam
- CHOC Children’s, Orange, California
| | - Rebecca Stern
- Internal Medicine-Pediatrics, University of Chicago Medical Center, Chicago, Illinois
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Kamal A, Zaki A, Abdelaaty A, Madkour M. Management of ST-segment elevation myocardial infarction in comparison to European society of cardiology guidelines in Alexandria University Hospitals, Egypt. Egypt Heart J 2023; 75:5. [PMID: 36680659 PMCID: PMC9867789 DOI: 10.1186/s43044-023-00332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND For patients with ST-elevation myocardial infarction (STEMI), early reperfusion with primary percutaneous coronary intervention (PPCI) or thrombolytic treatment is essential to prevent major adverse cardiac events. The aim of the study is to compare the current status of managing STEMI patients at **** with European Society of Cardiology guidelines recommendations. Prospective cohort of all patients presenting with ST-elevation myocardial infarction (STEMI) between March 2020 and February 2021 in Alexandria University hospitals. Reporting patterns, causes of delay, and reperfusion status for all STEMI patients were noted. MACE: (Mortality, Re-infarction, Stroke, or Heart failure) was reported and compared among different management strategies. RESULTS The study was conducted over one year on 436 patients, 280 (64.2%) of them underwent PPCI, 32 (7.3%) received thrombolysis, and 124 (28.5%) had a conservative strategy. Patients' mean age was 55.2 years, 72.2% were smokers and 80.9% were men. Family history was positive in 14.2% of patients, 33.5% had diabetes, 7.3% had renal impairment, and 41.5% had hypertension. The median pre-hospital waiting time was 360 min; the mean pre-hospital waiting time was 629.0 ± 796.7 min. The median Emergency Room waiting time was 48.24 ± 89.30 min. The median time from CCU admission to wire crossing was 40.0 min with a mean value 53.86 ± 49.0 min. The mean ischemia duration was 408 min, while the total ischemic time was 372 min. All patients who presented within 12 h received reperfusion therapy either a PPCI or thrombolysis at a rate of 71.5%, with 35.0% of those patients achieving prompt reperfusion in accordance with ESC guidelines. The PPCI group mortality rate was 2.9%, in comparison to 12.9% in the conservative group, which was statistically significant (P < 0.001). Overall in-hospital mortality was 5.5%, and total MACE was 27.3%. A statistically significant difference was observed between the three management groups as regards MACE rate, being 15%, 28.1%, and 54.8% in PPCI, thrombolysis, and conservative groups, respectively. CONCLUSIONS Despite financial and technical constraints, appropriate, timely reperfusion was near to achieving the ESC guidelines for the management of STEMI. The most common reperfusion strategy was PPCI, with an in-hospital death rate of less than 5% in the PPCI group. There was a concern about the increase in the total ischemia time due to some financial and technical constraints.
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Affiliation(s)
- Amr Kamal
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
| | - Amr Zaki
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
| | - Ahmed Abdelaaty
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
| | - Moustafa Madkour
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
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Liu ES, Hung CC, Chiang CH, Tsai YC, Fu YJ, Ko YL, Wang CL, Lai WY, Tsai FT, Kuo FY, Huang WC. Quality care in ST-segment elevation myocardial infarction. J Chin Med Assoc 2022; 85:268-275. [PMID: 34999635 DOI: 10.1097/jcma.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Over the past decades, the treatment of ST-segment elevation myocardial infarction (STEMI) has been redefined with the incorporation of evidence from multiple clinical trials. Recommendations from guidelines are updated regularly to reduce morbidity and mortality. However, heterogeneous care systems, physician perspectives, and patient behavior still lead to a disparity between evidence and clinical practice. The quality of care has been established and become an integral part of modern healthcare in order to increase the likelihood of desired health outcomes and adhere to professional knowledge. For patients with STEMI, measuring the quality of care is a multifactorial and multidimensional process that cannot be estimated solely based on patients' clinical outcomes. The care of STEMI is similar to the concept of "the chain of survival" that emphasizes the importance of seamless integration of five links: early recognition and diagnosis, timely reperfusion, evidence-based medications, control of cholesterol, and cardiac rehabilitation. Serial quality indicators, reflecting the full spectrum of care, have become a widely used tool for assessing performance. Comprehension of every aspect of quality assessment and indicators might be too demanding for a physician. However, it is worthwhile to understand the concepts involved in quality improvement since every physician wants to provide better care for their patients. This article reviews a fundamental approach to quality care in STEMI.
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Affiliation(s)
- En-Shao Liu
- Department of critical care medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Cheng Chung Hung
- Department of critical care medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Cheng-Hung Chiang
- Department of critical care medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Yi-Ching Tsai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yun-Ju Fu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Lin Ko
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Lin Wang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Yi Lai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fu-Ting Tsai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-You Kuo
- Department of critical care medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wei-Chun Huang
- Department of critical care medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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Jacobs AK, Ali MJ, Best PJ, Bieniarz MC, Bufalino VJ, French WJ, Henry TD, Hollowell L, Jauch EC, Kurz MC, Levy M, Patel P, Spier T, Stone RH, Tataris KL, Thomas RJ, Zègre-Hemsey JK. Systems of Care for ST-Segment-Elevation Myocardial Infarction: A Policy Statement From the American Heart Association. Circulation 2021; 144:e310-e327. [PMID: 34641735 DOI: 10.1161/cir.0000000000001025] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The introduction of Mission: Lifeline significantly increased timely access to percutaneous coronary intervention for patients with ST-segment-elevation myocardial infarction (STEMI). In the years since, morbidity and mortality rates have declined, and research has led to significant developments that have broadened our concept of the STEMI system of care. However, significant barriers and opportunities remain. From community education to 9-1-1 activation and emergency medical services triage and from emergency department and interfacility transfer protocols to postacute care, each critical juncture presents unique challenges for the optimal care of patients with STEMI. This policy statement sets forth recommendations for how the ideal STEMI system of care should be designed and implemented to ensure that patients with STEMI receive the best evidence-based care at each stage in their illness.
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11
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[Managing STEMI before the hospital : let's identify our enemies!]. Ann Cardiol Angeiol (Paris) 2021; 70:369-372. [PMID: 34753595 DOI: 10.1016/j.ancard.2021.10.017] [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: 11/23/2022]
Abstract
Managing a patient with chest pain suspected to be a ST segment elevation myocardial infarction is a race against time. This management is based on a chain, like what is presented for cardiac arrest. Three phases follow one another, with potential loss of time successively attributable to the patient, the emergency physician and then the cardiologist. It would be tempting to consider that the main culprit in the event of delayed treatment is the patient. This review is the opportunity to show that it is not the case. The emergency physician, the cardiologist and their interconnection are the main providers of delay and, as such, the main enemies of myocardial reperfusion.
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Scholz KH, Lengenfelder B, Jacobshagen C, Fleischmann C, Moehlis H, Olbrich HG, Jung J, Maier LS, Maier SK, Bestehorn K, Friede T, Meyer T. Long-term effects of a standardized feedback-driven quality improvement program for timely reperfusion therapy in regional STEMI care networks. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 10:2048872620907323. [PMID: 32723177 DOI: 10.1177/2048872620907323] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/24/2020] [Indexed: 02/24/2024]
Abstract
AIMS Current European Society of Cardiology guidelines state that repetitive monitoring and feedback should be implemented for ST-elevation myocardial infarction (STEMI) treatment, but no evidence is available supporting this recommendation. We aimed to analyze the long-term effects of a formalized data assessment and systematic feedback on performance and mortality within the prospective, multicenter Feedback Intervention and Treatment Times in STEMI (FITT-STEMI) study. METHODS Regular interactive feedback sessions with local STEMI management teams were performed at six participating German percutaneous coronary intervention (PCI) centers over a 10-year period starting from October 2007. RESULTS From the first to the 10th year of study participation, all predefined key-quality indicators for performance measurement used for feedback improved significantly in all 4926 consecutive PCI-treated patients - namely, the percentages of patients with pre-hospital electrocardiogram (ECG) recordings (83.3% vs 97.1%, p < 0.0001) and ECG recordings within 10 minutes after first medical contact (41.7% vs 63.8%, p < 0.0001), pre-announcement by telephone (77.0% vs 85.4%, p = 0.0007), direct transfer to the catheterization laboratory bypassing the emergency department (29.4% vs 64.2%, p < 0.0001), and contact-to-balloon times of less than 90 minutes (37.2% vs 53.7%, p < 0.0001). Moreover, this feedback-related continuous improvement of key-quality indicators was linked to a significant reduction in in-hospital mortality from 10.8% to 6.8% (p = 0.0244). Logistic regression models confirmed an independent beneficial effect of duration of study participation on hospital mortality (odds ratio = 0.986, 95% confidence interval = 0.976-0.996, p = 0.0087). In contrast, data from a nationwide PCI registry showed a continuous increase in in-hospital mortality in all PCI-treated STEMI patients in Germany from 2008 to 2015 (n = 398,027; 6.7% to 9.2%, p < 0.0001). CONCLUSIONS Our results indicate that systematic data assessment and regular feedback is a feasible long-term strategy and may be linked to improved performance and a reduction in mortality in STEMI management.
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Affiliation(s)
| | - Björn Lengenfelder
- Department of Cardiology, University of Würzburg, Germany
- Comprehensive Heart Failure Center Würzburg, Würzburg, Germany
| | - Claudius Jacobshagen
- Department of Cardiology, Heart Center, University of Göttingen, Göttingen, Germany
| | | | - Hiller Moehlis
- Department of Cardiology, Klinikum Darmstadt, Darmstadt, Germany
| | - Hans G Olbrich
- Department of Cardiology, Asklepios Klinik Langen, Langen, Germany
| | - Jens Jung
- Department of Cardiology, Klinikum Worms, Worms, Germany
| | - Lars S Maier
- Department of Cardiology, University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Kg Maier
- Comprehensive Heart Failure Center Würzburg, Würzburg, Germany
- Department of Cardiology, Klinikum Straubing, Straubing, Germany
| | - Kurt Bestehorn
- Institute for Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Thomas Meyer
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 3870] [Impact Index Per Article: 967.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Gabet A, Danchin N, Puymirat E, Tuppin P, Olié V. Early and late case fatality after hospitalization for acute coronary syndrome in France, 2010-2015. Arch Cardiovasc Dis 2019; 112:754-764. [PMID: 31718932 DOI: 10.1016/j.acvd.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/08/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Case-fatality data for acute coronary syndromes (ACS) are scarce in unselected French patients. AIMS To analyse early and late case-fatality rates in patients with ACS in France, case fatality determinants and time trends between 2010 and 2015. METHODS For each year from 2010 to 2015, all patients hospitalized for ACS in France and aged>18 years were selected. Multivariable Cox models were used to assess determinants of case fatality at 3 days, 4-30 days and 31-365 days after hospital admission. RESULTS In 2015, cumulative 3-day, 30-day and 1-year case-fatality rates were, respectively, 2.0%, 5.1% and 11.1% for all patients with ACS, and 3.9%, 8.5% and 13.8% for those with ST-segment elevation myocardial infarction (STEMI). Admission through the emergency department was associated with a higher risk of death, particularly at 3 days. Female sex was associated with higher case-fatality rates at 3 days, but with lower case-fatality rates at 31-365 days. Social deprivation was associated with higher case-fatality rates for all periods for all patients with ACS. A significant decrease was found between 2010 and 2015 in case-fatality rates at 31-365 days, particularly for patients with STEMI; this time trend was no longer significant after additional adjustment for hospital management. CONCLUSIONS Case fatality up to 1 year after hospitalization for ACS was non-negligible, highlighting the need to ensure better follow-up after the acute stage, particularly in the most deprived patients. As hospital admission through the emergency department still occurs frequently, health policy should promote a national campaign to increase the awareness and preparedness of the general population regarding ACS. Finally, our results suggest that women need specific attention early after the index event.
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Affiliation(s)
- Amélie Gabet
- French Public Health Agency, 94410 Saint-Maurice, France.
| | - Nicolas Danchin
- Department of cardiology, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Etienne Puymirat
- Department of cardiology, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Philippe Tuppin
- General Health Insurance Scheme (Caisse nationale d'assurance maladie), 75020 Paris, France
| | - Valérie Olié
- French Public Health Agency, 94410 Saint-Maurice, France
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15
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Jouffroy R, Saade A, Philippe P, Carli P, Vivien B. Impact of Prehospital Mobile Intensive Care Unit Intervention on Mortality of Patients with Sepsis. Turk J Anaesthesiol Reanim 2019; 47:334-341. [PMID: 31380515 PMCID: PMC6645836 DOI: 10.5152/tjar.2019.26576] [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: 07/26/2018] [Accepted: 09/18/2018] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVE The outcome of sepsis relies on the early diagnosis and implementation of appropriate treatments. For management of out-of-hospital patients with sepsis, prehospital emergency services, named Service d'Aide Médicale d'Urgence (SAMU) in France, dispatch to the scene an emergency mobile team (EMT) or a mobile intensive care unit (MICU) based on the patient's severity. Therefore, patients are admitted to the emergency department (ED) or to the intensive care unit (ICU). The impact of MICU intervention on patient's prognosis remains unclear. The aim of the present study was to describe the impact of MICU intervention on mortality on day 28 (D28) of patients with sepsis. METHODS We performed a retrospective study on patients with sepsis managed by prehospital teams, MICU or EMT, before admission to the ED or ICU. The primary outcome was mortality on D28. RESULTS The SAMU received 30,642 calls during the study period with 140 patients with suspected sepsis. The suspected origin of sepsis was mainly pulmonary for 78 (55%) patients. Thirteen (9%) patients died on D28, 12 in the ED and 1 in the ICU. Two patients were admitted to the hospital by a MICU. After adjusting for confounding factors, the relative risk of mortality on D28 for patients admitted to the hospital by a MICU was 0.40. CONCLUSION We describe an association between MICU intervention and mortality on D28. MICU intervention for out-of-hospital patients with sepsis is associated with 60% reduced mortality on D28. Larger studies are needed to confirm the impact of the intervention of MICU on mortality of patients with sepsis.
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Affiliation(s)
- Romain Jouffroy
- Department of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Necker, University Paris Descartes, Paris, France
| | - Anastasia Saade
- Department of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Necker, University Paris Descartes, Paris, France
| | - Pascal Philippe
- Department of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Necker, University Paris Descartes, Paris, France
| | - Pierre Carli
- Department of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Necker, University Paris Descartes, Paris, France
| | - Benoit Vivien
- Department of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Necker, University Paris Descartes, Paris, France
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16
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Balen F, Lhermusier T, Grolleau S, Pélissier F, Dehours E, Charpentier S, Azema O, Lamy S. Identifying key factors leading to the optimal care pathway for patients with ST-segment elevation myocardial infarction: Results from the RESCAMIP registry. Arch Cardiovasc Dis 2019; 112:374-380. [PMID: 31160206 DOI: 10.1016/j.acvd.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/27/2018] [Accepted: 01/24/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND In France, when someone presents with chest pain, it is recommended to call a health emergency number. The patient talks with an emergency doctor at a medical dispatch centre, who decides whether (or not) to send a Mobile Intensive Care Unit (MICU). Patients with an ST-segment elevation myocardial infarction (STEMI) should have an MICU as their first medical contact, to speed up confirmation of diagnosis and enable them to benefit from reperfusion therapy as quickly as possible. AIM To evaluate the proportion of patients with STEMI benefiting from an optimal care pathway, and to identify the key factors leading to this pathway. METHODS RESCAMIP was a multicentre registry conducted between May 2015 and May 2017 in Midi-Pyrénées. All patients treated for STEMI within 12hours of symptoms onset, without initially going into cardiac arrest, were included. RESULTS Data from 1371 patients with STEMI were analysed; 60% had an MICU as their first medical contact. In-hospital mortality was 4%. Factors associated with calling the medical dispatch centre when presenting chest pain were: age>65 years (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.02-1.83), personal history of cardiovascular disease (OR 1.9, 95% CI 1.22-2.96) and having cardiovascular risk factors (OR 1.84, 95% CI 1.35-2.5). Factors associated with sending an MICU as first medical contact were: male sex (OR 2.11, 955 CI 1.49-2.99) and personal history of cardiovascular disease (OR 1.69, 95% CI 1.07-2.65). CONCLUSIONS The proportion of patients with STEMI going through non-optimal pathways was 40% in our area. We note that there are sex-based inequalities in accessing MICUs.
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Affiliation(s)
- Frederic Balen
- Emergency Department, Toulouse University Hospital, 31059 Toulouse, France; Laboratory of Epidemiology and Analyses in Public Health, UMR 1027 INSERM, 31000 Toulouse, France; Toulouse III-Paul Sabatier University, 31330 Toulouse, France.
| | | | - Sabrina Grolleau
- Regional Observatory of Emergency Medicine in Midi-Pyrénées, Toulouse University Hospital, 31059 Toulouse, France
| | - Fanny Pélissier
- Poison Control Centre, Toulouse University Hospital, 31059 Toulouse, France
| | - Emilie Dehours
- Emergency Department, Toulouse University Hospital, 31059 Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital, 31059 Toulouse, France; Laboratory of Epidemiology and Analyses in Public Health, UMR 1027 INSERM, 31000 Toulouse, France; Toulouse III-Paul Sabatier University, 31330 Toulouse, France
| | - Olivier Azema
- Regional Observatory of Emergency Medicine in Midi-Pyrénées, Toulouse University Hospital, 31059 Toulouse, France
| | - Sebastien Lamy
- Laboratory of Epidemiology and Analyses in Public Health, UMR 1027 INSERM, 31000 Toulouse, France
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17
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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18
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Scholz KH, Friede T, Meyer T, Jacobshagen C, Lengenfelder B, Jung J, Fleischmann C, Moehlis H, Olbrich HG, Ott R, Elsässer A, Schröder S, Thilo C, Raut W, Franke A, Maier LS, Maier SK. Prognostic significance of emergency department bypass in stable and unstable patients with ST-segment elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 9:34-44. [PMID: 30477317 PMCID: PMC7047304 DOI: 10.1177/2048872618813907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In ST-segment elevation myocardial infarction (STEMI) patients treated with percutaneous coronary intervention, direct transport from the scene to the catheterisation laboratory bypassing the emergency department has been shown to shorten times to reperfusion. The aim of this study was to investigate the effects of emergency department bypass on mortality in both haemodynamically stable and unstable STEMI patients. Methods: The analysis is based on a large cohort of STEMI patients prospectively included in the German multicentre Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) trial. Results: Out of 13,219 STEMI patients who were brought directly from the scene by emergency medical service transportation and were treated with percutaneous coronary intervention, the majority were transported directly to the catheterisation laboratory bypassing the emergency department (n=6740, 51% with emergency department bypass). These patients had a significantly lower in-hospital mortality than their counterparts with no emergency department bypass (6.2% vs. 10.0%, P<0.0001). The reduced mortality related to emergency department bypass was observed in both stable (n=11,594, 2.8% vs. 3.8%, P=0.0024) and unstable patients presenting with cardiogenic shock (n=1625, 36.3% vs. 46.2%, P<0.0001). Regression models adjusted for the Thrombolysis In Myocardial Infarction (TIMI) risk score consistently confirmed a significant and independent predictive effect of emergency department bypass on survival in the total study population (odds ratio 0.64, 95% confidence interval 0.56–0.74, P<0.0001) and in the subgroup of shock patients (OR 0.69, 95% CI 0.54–0.88, P=0.0028). Conclusion: In STEMI patients, emergency department bypass is associated with a significant reduction in mortality, which is most pronounced in patients presenting with cardiogenic shock. Our data encourage treatment protocols for emergency department bypass to improve the survival of both haemodynamically stable patients and, in particular, unstable patients. Clinical Trial Registration: NCT00794001 ClinicalTrials.gov: NCT00794001
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Affiliation(s)
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany
| | - Thomas Meyer
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, Germany
| | - Claudius Jacobshagen
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany.,Department of Cardiology and Pneumology, University of Göttingen, Germany
| | - Björn Lengenfelder
- Department of Cardiology, University of Würzburg, Germany.,Comprehensive Heart Failure Center Würzburg, Germany
| | - Jens Jung
- Department of Cardiology, Klinikum Worms, Germany
| | | | | | - Hans G Olbrich
- Department of Cardiology, Asklepios Klinik Langen, Germany
| | - Rainer Ott
- Department of Cardiology, Helios Klinikum Krefeld, Germany
| | | | | | | | - Werner Raut
- Department of Cardiology, Community Hospital Buchholz, Germany
| | - Andreas Franke
- Department of Cardiology, Klinikum Siloah Region Hannover, Germany
| | - Lars S Maier
- Department of Cardiology, University Hospital Regensburg, Germany
| | - Sebastian Kg Maier
- Comprehensive Heart Failure Center Würzburg, Germany.,Department of Cardiology, Klinikum Straubing, Germany
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19
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Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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20
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Keys to Achieving Target First Medical Contact to Balloon Times and Bypassing Emergency Department More Important Than Distance. Cardiol Res Pract 2018; 2018:2951860. [PMID: 29951310 PMCID: PMC5987289 DOI: 10.1155/2018/2951860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/27/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022] Open
Abstract
Background Australian guidelines advocate primary percutaneous coronary intervention (PPCI) as the reperfusion strategy of choice for ST elevation myocardial infarction (STEMI) in patients in whom it can be performed within 90 minutes of first medical contact; otherwise, fibrinolytic therapy is preferred. In a large health district, the reperfusion strategy is often chosen in the prehospital setting. We sought to identify a distance from a PCI centre, which made it unlikely first medical contact to balloon time (FMCTB) of less than 90 minutes could be achieved in the Hunter New England health district and to identify causes of delay in patients who were triaged to a PPCI strategy. Methods and Results We studied 116 patients presenting via the ambulance service with STEMI from January 2016 to December 2016. In patients who were taken directly to the cardiac catheterisation lab, a maximum distance of 50 km from hospital resulted in 75% of patients receiving PCI within 90 minutes and approximately 95% of patients receiving PCI within 120 minutes. Patients who bypassed the emergency department (ED) were significantly more likely to have FMCTB of less than 90 minutes (p < 0.001) despite having a longer travel distance (28.5 km versus 17.4 km, p < 0.001). Patients transiting via the ED were significantly more likely to present out of hours (60 versus 24.2% p < 0.001). Conclusions Patients who do not bypass the ED have a longer FMCTB across all spectrum of distances from the PCI centre; therefore, bypassing the ED is key to achieving target FMCTB times. Using a cutoff distance of 50 km may reduce human error in estimating travel time to our PCI centre and thereby identifying patients who should receive prehospital thrombolysis.
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21
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Jouffroy R, Saade A, Ellouze S, Carpentier A, Michaloux M, Carli P, Vivien B. Prehospital triage of septic patients at the SAMU regulation: Comparison of qSOFA, MRST, MEWS and PRESEP scores. Am J Emerg Med 2018; 36:820-824. [DOI: 10.1016/j.ajem.2017.10.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 01/04/2023] Open
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22
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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: 6056] [Impact Index Per Article: 1009.3] [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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23
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Jouffroy R, Saade A, Carpentier A, Ellouze S, Philippe P, Idialisoa R, Carli P, Vivien B. Triage of Septic Patients Using qSOFA Criteria at the SAMU Regulation: A Retrospective Analysis. PREHOSP EMERG CARE 2017; 22:84-90. [DOI: 10.1080/10903127.2017.1347733] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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24
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Mehta S, Botelho R, Cade J, Perin M, Bojanini F, Coral J, Parra D, Ferré A, Castillo M, Yépez P. Global Challenges and Solutions: Role of Telemedicine in ST-Elevation Myocardial Infarction Interventions. Interv Cardiol Clin 2017; 5:569-581. [PMID: 28582005 DOI: 10.1016/j.iccl.2016.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Major disparities exist between developed and developing countries in the management of acute myocardial infarction (AMI). These pronounced differences result in significantly increased morbidity and mortality from AMI in different regions of the world. Lack of infrastructure, insurance, facilities, and skilled personnel are the major constraints. Primary percutaneous coronary intervention has revolutionized the treatment of AMI; however, its global use is limited by the listed constraints. Telemedicine provides an efficient methodology that can hugely increase access and accuracy of AMI management.
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Affiliation(s)
- Sameer Mehta
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA.
| | - Roberto Botelho
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Jamil Cade
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Marco Perin
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Fredy Bojanini
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Juan Coral
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Daniela Parra
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Alexandra Ferré
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Marco Castillo
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Pablo Yépez
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
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25
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Schiele F, Gale CP, Bonnefoy E, Capuano F, Claeys MJ, Danchin N, Fox KAA, Huber K, Iakobishvili Z, Lettino M, Quinn T, Rubini Gimenez M, Bøtker HE, Swahn E, Timmis A, Tubaro M, Vrints C, Walker D, Zahger D, Zeymer U, Bueno H. Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:34-59. [DOI: 10.1177/2048872616643053] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Francois Schiele
- University Hospital of Besancon, EA3920 University of Franche-Comté, Besançon, France
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds; York Teaching Hospital NHS Foundation Trust, York, UK
| | - Eric Bonnefoy
- Unité de soins intensifs cardiologiques, Hôpital Cardiologique Louis-Pradel, Bron, France
| | | | - Marc J Claeys
- Cardiology Department, University Hospital Antwerp, Edegem, Belgium
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP); Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Keith AA Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | | | | | - Tom Quinn
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Maria Rubini Gimenez
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel
| | - Hans E Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Eva Swahn
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden
| | - Adam Timmis
- National Institute for Health Research Biomedical Research Unit, Barts Heart Centre, London, UK
| | | | | | - David Walker
- East Sussex Healthcare, Conquest Hospital, Hastings, UK
| | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Hector Bueno
- Centro Nacional de InvestigacionesCardiovasculares (CNIC), Cardiology Department, Hospital Universitario 12 de Octubre, and Universidad Complutense de Madrid, Madrid, Spain
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26
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Mode of admission and its effect on adherence to reperfusion therapy guidelines in Belgian STEMI patients. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:461-7. [DOI: 10.1177/2048872616647708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/29/2016] [Indexed: 01/27/2023]
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27
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An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care. BIOMED RESEARCH INTERNATIONAL 2015; 2015:868653. [PMID: 26558286 PMCID: PMC4629003 DOI: 10.1155/2015/868653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/16/2015] [Accepted: 07/26/2015] [Indexed: 12/03/2022]
Abstract
The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review.
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28
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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29
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 2015; 17:1601-87. [PMID: 26318695 DOI: 10.1093/europace/euv319] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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30
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36:2793-2867. [PMID: 26320108 DOI: 10.1093/eurheartj/ehv316] [Citation(s) in RCA: 2530] [Impact Index Per Article: 281.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Acute Disease
- Aged
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/therapy
- Autopsy/methods
- Cardiac Resynchronization Therapy/methods
- Cardiomyopathies/complications
- Cardiomyopathies/therapy
- Cardiotonic Agents/therapeutic use
- Catheter Ablation/methods
- Child
- Coronary Artery Disease/complications
- Coronary Artery Disease/therapy
- Death, Sudden, Cardiac/prevention & control
- Defibrillators
- Drug Therapy, Combination
- Early Diagnosis
- Emergency Treatment/methods
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Heart Transplantation/methods
- Heart Valve Diseases/complications
- Heart Valve Diseases/therapy
- Humans
- Mental Disorders/complications
- Myocardial Infarction/complications
- Myocardial Infarction/therapy
- Myocarditis/complications
- Myocarditis/therapy
- Nervous System Diseases/complications
- Nervous System Diseases/therapy
- Out-of-Hospital Cardiac Arrest/therapy
- Pregnancy
- Pregnancy Complications, Cardiovascular/therapy
- Primary Prevention/methods
- Quality of Life
- Risk Assessment
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/therapy
- Sports/physiology
- Stroke Volume/physiology
- Terminal Care/methods
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/therapy
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31
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[Evolution since 2002 of the management of patients with ST elevated acute coronary syndrome (STEMI) in Île-de-France. E-MUST survey]. Presse Med 2015; 44:e273-81. [PMID: 25960444 DOI: 10.1016/j.lpm.2015.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 11/21/2014] [Accepted: 01/12/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION ST-segment-elevation acute myocardial infarction (STEMI) is a therapeutic emergency. Early reperfusion is the key to successful reperfusion. Guidelines recommend organizing regional networks. In France, this starts with a call to a medical dispatch center, the SAMU-centre 15. The aim of this study was to evaluate regional STEMI management using data collected from 2002 to 2010. METHODS Observational, prospective, multicenter survey. STEMI patient with chest pain lasting for less than 24hours managed by 40 mobile emergency and resuscitation service (SMUR) and 8 emergency medical system (SAMU) from the Greater Paris Area (Île-de-France) were analyzed. Demographic data, cardiovascular risk factors, infarction location, decision of reperfusion and delays were collected. The rate of coronary reperfusion was chosen as the primary endpoint. RESULTS Eleven thousand five hundred and eighty-eight patients enrolled from 2002 to 2010 were analyzed. Median age was 59.9 (51.0 to 72.9) years; 9080 (78.5%) were men. The number of patients included decreased from 1376 in 2002 to 1119 in 2010. Reperfusion was achieved by fibrinolysis in 2644 (23%) cases and primary angioplasty in 7999 (69%) cases. The rate of decision of coronary reperfusion significantly increased from 86.7% in 2002 to 94.8% in 2010 (P<0.0001). Interaction between the increasing decision of reperfusion and all factors studied (demographics, cardiovascular risk factors, infarct location and delays) was significant only for family history of coronary artery disease (P=0.03). In-hospital mortality was 2.8% (321 cases). CONCLUSION The number of patients with STEMI managed by the SAMU declined slightly over the past decade. The rate of decision of reperfusion progressively increased up to 95%. Entrance into the network by the SAMU-centre 15 is a guarantee of a wide and early access to the coronary reperfusion.
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Ilic I, Stankovic I, Vidakovic R, Jovanovic V, Vlahovic Stipac A, Putnikovic B, Neskovic AN. Relationship of ischemic times and left atrial volume and function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Int J Cardiovasc Imaging 2015; 31:709-16. [PMID: 25648258 DOI: 10.1007/s10554-015-0603-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/27/2015] [Indexed: 01/06/2023]
Abstract
Little is known about the impact of duration of ischemia on left atrial (LA) volumes and function during acute phase of myocardial infarction. We investigated the relationship of ischemic times, echocardiographic indices of diastolic function and LA volumes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). A total of 433 consecutive STEMI patients underwent echocardiographic examination within 48 h of primary PCI, including the measurement of LA volumes and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e'). Time intervals from onset of chest pain to hospital admission and reperfusion were collected and magnitude of Troponin I release was used to assess infarct size. Patients with LA volume index (LAVI) ≥28 ml/m(2) had longer total ischemic time (410 ± 347 vs. 303 ± 314 min, p = 0.007) and higher E/e' ratio (15 ± 5 vs. 10 ± 3, p < 0.001) than those with LAVI <28 ml/m(2), while the indices of LA function were similar between the study groups (p > 0.05, for all). Significant correlation was found between E/e' and LA volumes at all stages of LA filling and contraction (r = 0.363-0.434; p < 0.001, for all) while total ischemic time along with E/e' and restrictive filling pattern remained independent predictor of LA enlargement. Increased LA volume is associated with longer ischemic times and may be a sensitive marker of increased left ventricular filling pressures in STEMI patients treated with primary PCI.
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Affiliation(s)
- Ivan Ilic
- Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, 11080, Belgrade, Serbia,
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3299] [Impact Index Per Article: 329.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Franco E, Mateos A, Acebal C, Fernández-Ortiz A, Sánchez-Brunete V, García-Rubira JC, Fernández-Campos MJ, Macaya C, Ibáñez B. Prehospital activation of cardiac catheterization teams in ST-segment elevation myocardial infarction. Rev Port Cardiol 2014; 33:545-53. [PMID: 25216540 DOI: 10.1016/j.repc.2014.03.007] [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: 02/04/2014] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Current clinical guidelines for ST-segment elevation myocardial infarction (STEMI) suggest prehospital activation of the cardiac catheterization team. In previous protocols in our center activation occurred once patients arrived at the hospital. In January 2011, we initiated a new primary angioplasty activation protocol from prehospital locations. Our objective was to quantify the influence of this change on reperfusion times. METHODS A total of 173 consecutive STEMI patients (n=73/100 before/after initiation of the new protocol), diagnosed in a prehospital setting within 12 hours of symptom onset, were analyzed. The time between the patient's arrival at the hospital and beginning of the angioplasty procedure was termed the cath lab activation delay. RESULTS The new protocol resulted in a 37-min reduction in system delay (166 [132-235] min before vs. 129 [105-166] min after, p<0.001), mostly driven by a 64% reduction in cath lab activation delay (55 [0-79] min before vs. 20 [0-54] min after, p=0.001). This reduction was mainly observed outside working hours. The percentage of patients treated with a system delay ≤ 120 min increased from 14.5% before the new protocol to 41.8% afterwards (p=0.001). CONCLUSIONS Prehospital activation of the cardiac catheterization team resulted in earlier reperfusion of STEMI patients.
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Affiliation(s)
- Eduardo Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Alonso Mateos
- Servicio de Urgencia Médica de Madrid (SUMMA 112), Madrid, Spain
| | - Carlos Acebal
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | | | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Borja Ibáñez
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Franco E, Mateos A, Acebal C, Fernández-Ortiz A, Sánchez-Brunete V, García-Rubira JC, Fernández-Campos MJ, Macaya C, Ibáñez B. Prehospital activation of cardiac catheterization teams in ST-segment elevation myocardial infarction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Estévez-Loureiro R, López-Sainz &A, Pérez de Prado A, Cuellas C, Calviño Santos R, Alonso-Orcajo N, Salgado Fernández J, Vázquez-Rodríguez JM, López-Benito M, Fernández-Vázquez F. Timely reperfusion for ST-segment elevation myocardial infarction: Effect of direct transfer to primary angioplasty on time delays and clinical outcomes. World J Cardiol 2014; 6:424-433. [PMID: 24976914 PMCID: PMC4072832 DOI: 10.4330/wjc.v6.i6.424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/09/2014] [Indexed: 02/07/2023] Open
Abstract
Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction (STEMI) when it can be performed expeditiously and by experienced operators. In spite of excellent clinical results this technique is associated with longer delays than thrombolysis and this fact may nullify the benefit of selecting this therapeutic option. Several strategies have been proposed to decrease the temporal delays to deliver PPCI. Among them, prehospital diagnosis and direct transfer to the cath lab, by-passing the emergency department of hospitals, has emerged as an attractive way of diminishing delays. The purpose of this review is to address the effect of direct transfer on time delays and clinical events of patients with STEMI treated by PPCI.
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MEHTA SAMEER, BOTELHO ROBERTO, RODRIGUEZ DANIEL, FERNÁNDEZ FRANCISCOJ, OSSA MARIAM, ZHANG TRACY, KOSTELA JENNIFERC, REYNBAKH OLGA, FALCÃO BRENO, VELÁSQUEZ ALICIAHENAO, OLIVEROS ESTEFANIA, PENA CAMILO. A Tale of Two Cities: STEMI Interventions in Developed and Developing Countries and the Potential of Telemedicine to Reduce Disparities in Care. J Interv Cardiol 2014; 27:155-66. [DOI: 10.1111/joic.12117] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- SAMEER MEHTA
- University of Miami; Miller School of Medicine; Miami Florida
- Lumen Foundation; Miami Florida
| | | | | | | | - MARIA M. OSSA
- University of Miami; Miller School of Medicine; Miami Florida
- Lumen Foundation; Miami Florida
| | - TRACY ZHANG
- University of Miami; Miller School of Medicine; Miami Florida
- Lumen Foundation; Miami Florida
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Radke PW, Halvorsen S, Jukema JW, Kolh P, Annemans L, Postma MJ, Ardissino D, Kristensen SD, Bassand JP, Collet JP, Morais J, Tuñón J, Halcox J. Networks for improving care in patients with acute coronary syndrome: A framework. ACTA ACUST UNITED AC 2014; 16:41-8. [PMID: 24654609 DOI: 10.3109/17482941.2014.881502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In recent years, it has become evident that the level of guideline adherence in patients presenting with acute coronary syndrome (ACS) is highly correlated with patient outcomes. Unfortunately, guideline adherence is low in some geographic areas and especially in those patients at high-risk. Regional networks including ambulance systems and hospitals with catheterization laboratories are able to increase guideline adherence and patient outcomes by streamlining the critical pre- and intra-hospital processes as well as improving timely access to invasive procedures and recommended medication. Successful organization of an ACS network requires engagement of multiple stakeholders to create effective solutions for the specific local setting. There is no 'one-size-fits all' strategy to set-up and successfully run an ACS network. We present a framework for how to set up and organize an effective ACS network, delivering guideline-based care to improve patient outcomes.
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Affiliation(s)
- Peter W Radke
- Klinik für Innere Medizin, Schön Klinik Neustadt , Neustadt i.H. , Germany
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Chain of care in chest pain — Differences between three hospitals in an urban area. Int J Cardiol 2013; 166:440-7. [DOI: 10.1016/j.ijcard.2011.10.139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 10/10/2011] [Accepted: 10/30/2011] [Indexed: 11/23/2022]
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Quelle place pour les « Chest Pain Unit » dans la filière française de prise en charge des syndromes coronaires ? Le point de vue des urgentistes. Presse Med 2013; 42:1039-41. [DOI: 10.1016/j.lpm.2013.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/06/2013] [Indexed: 11/21/2022] Open
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Leleu H, Capuano F, Ferrua M, Nitenberg G, Minvielle E, Schiele F. Symptom-to-needle times in ST-segment elevation myocardial infarction: Shortest route to a primary coronary intervention facility. Arch Cardiovasc Dis 2013; 106:162-8. [DOI: 10.1016/j.acvd.2012.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 12/12/2012] [Accepted: 12/20/2012] [Indexed: 11/26/2022]
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Enhancing the efficacy of delivering reperfusion therapy: a European and North American experience with ST-segment elevation myocardial infarction networks. Am Heart J 2013; 165:123-32. [PMID: 23351814 DOI: 10.1016/j.ahj.2012.10.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 10/26/2012] [Indexed: 11/20/2022]
Abstract
Advances in technique and adjunctive medication have improved outcome of ST-segment elevation myocardial infarction (STEMI) patients. However, the timely delivery and administration of reperfusion strategies to all eligible patients remain challenging. Currently, up to one-third of eligible STEMI patients in industrialized countries worldwide receive no specific reperfusion treatment, a problem that is rectified by the development and implementation of STEMI networks, as also recommended by the latest European Society of Cardiology and American College of Cardiology/American Heart Association guidelines. Indeed, over the last 5 years, published figures demonstrate that STEMI networks increase the percentage of patients treated by any reperfusion strategy, and the percentage of patients receiving treatment within the recommended time frames has also improved, thereby reducing in-hospital and long-term mortality to very low levels. This manuscript demonstrates how STEMI networks can be adapted to local needs and circumstances against pre-existing barriers and despite the heterogeneity in local situations, patient's characteristics, treatment delays, and distances for transfer. Modern and efficacious networks must be prepared to offer both primary percutaneous coronary intervention and thrombolytic therapy, preferably prehospital, as long as primary percutaneous coronary intervention cannot be guaranteed to all individuals within the recommended timeline.
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Steg G, James SK, Atar D, Badano LP, Blomstrom Lundqvist C, A. Borger M, di Mario C, Dickstein K, Ducrocq G, Fernández-Avilés F, H. Gershlick A, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, J. Lenzen M, W. Mahaffey K, Valgimigli M, van’t Hof A, Widimsky P, Zahger D, J. Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Astin F, Astrom-Olsson K, Budaj A, Clemmensen P, Collet JP, Fox KA, Fuat A, Gustiene O, Hamm CW, Kala P, Lancellotti P, Pietro Maggioni A, Merkely B, Neumann FJ, Piepoli MF, Werf FVD, Verheugt F, Wallentin L. Guía de práctica clínica de la ESC para el manejo del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van 't Hof A, Widimsky P, Zahger D. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33:2569-619. [PMID: 22922416 DOI: 10.1093/eurheartj/ehs215] [Citation(s) in RCA: 3656] [Impact Index Per Article: 304.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
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- AP-HP, Hôpital Bichat / Univ Paris Diderot, Sorbonne Paris-Cité / INSERM U-698, Paris, France.
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Superior outcome with direct catheter laboratory access vs ED-activated primary percutaneous coronary intervention. Am J Emerg Med 2012; 30:1118-24. [DOI: 10.1016/j.ajem.2011.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 06/28/2011] [Accepted: 07/15/2011] [Indexed: 11/16/2022] Open
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Wennman I, Klittermark P, Herlitz J, Lernfelt B, Kihlgren M, Gustafsson C, Hansson PO. The clinical consequences of a pre-hospital diagnosis of stroke by the emergency medical service system. A pilot study. Scand J Trauma Resusc Emerg Med 2012; 20:48. [PMID: 22781159 PMCID: PMC3477056 DOI: 10.1186/1757-7241-20-48] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 06/06/2012] [Indexed: 11/26/2022] Open
Abstract
Background There is still a considerable delay between the onset of symptoms and arrival at a stroke unit for most patients with acute stroke. The aim of the study was to describe the feasibility of a pre-hospital diagnosis of stroke by an emergency medical service (EMS) nurse in terms of diagnostic accuracy and delay from dialing 112 until arrival at a stroke unit. Methods Between September 2008 and November 2009, a subset of patients with presumed acute stroke in the pre-hospital setting were admitted by EMS staff directly to a stroke unit, bypassing the emergency department. A control group, matched for a number of background variables, was created. Results In all, there were 53 patients in the direct admission group, and 49 patients in the control group. The median delay from calling for an ambulance until arrival at a stroke unit was 54 minutes in the direct admission group and 289 minutes in the control group (p < 0.0001). In a comparison between the direct admission group and the control group, a final diagnosis of stroke, transient ischemic attack (TIA) or the sequelae of prior stroke was found in 85% versus 90% (NS). Among stroke patients who lived at home prior to the event, the percentage of patients that were living at home after 3 months was 71% and 62% respectively (NS). Conclusions In a pilot study, the concept of a pre-hospital diagnosis of stroke by an EMS nurse was associated with relatively high diagnostic accuracy in terms of stroke-related diagnoses and a short delay to arrival at a stroke unit. These data need to be confirmed in larger studies, with a concomitant evaluation of the clinical consequences and, if possible, the level of patient satisfaction as well.
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Affiliation(s)
- Ingela Wennman
- Department of Ambulance and Pre-hospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Sandouk A, Ducassé JL, Grolleau S, Azéma O, Elbaz M, Farah B, Tidjane A, Kelly-Irving M, Charpentier S. Compliance with guidelines in patients with ST-segment elevation myocardial infarction after implementation of specific guidelines for emergency care: Results of RESCA+31 registry. Arch Cardiovasc Dis 2012; 105:262-70. [DOI: 10.1016/j.acvd.2012.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 03/04/2012] [Accepted: 03/06/2012] [Indexed: 11/26/2022]
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Georges JL, Ben-Hadj I, Gibault-Genty G, Blicq E, Aziza JP, Ben-Jemaa K, Moro J, Koukabi M, Livarek B. [Accuracy of the door-to-balloon time for assessing the result of the interventional reperfusion strategy in acute ST-segment elevation myocardial infarction]. Ann Cardiol Angeiol (Paris) 2011; 60:244-251. [PMID: 21978820 DOI: 10.1016/j.ancard.2011.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 07/24/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND In patients with acute ST-segment elevation myocardial infarction (STEMI), recent clinical guidelines recommend that primary percutaneous coronary intervention (PCI) should be performed within 90min of first medical contact or 45min after admission in cathlab. The Door-to-Balloon time (D2B) is widely used to measure the performance of interventional centres. AIM OF THE STUDY To analyze the time to reperfusion in a consecutive series of STEMI patients referred for primary PCI, and to evaluate the clinical accuracy of D2B in primary PCI. METHODS From January 2007 to March 2008, 177 patients were admitted within 12hours of a STEMI in our institution, and 87 were referred for a direct coronary angiography for primary PCI (47 by mobile medical emergency unit, 40 by the emergency department of the institution). RESULTS The median time from first medical contact to balloon inflation (M2B) was 135min [IQR 112-183]. Recommended times were fulfilled in a minority of patients (M2B<90min: 9%,<120min: 34%). Median cathlab D2B was 51min [IQR 44-65], and was less than 45min in 34% of patients. No differences for times to reperfusion within cathlab were found between in- and off-time hours. M2B and D2B were unavailable in 23 patients (26%), because of a spontaneous TIMI 3 flow reperfusion without indication for immediate PCI in 20 patients, contra-indication for PCI in two (distal occlusion, culprit vessel diameter less than 2mm), and failure in occlusion crossing by the guide-wire in one patient. In contrast, first medical contact- or door-to-reperfusion times, assessed by a TIMI 3 flow without no-reflow in culprit artery, were available in 95% of patients, and were shorter than M2B or D2B, respectively. CONCLUSION Although it is a feasible and reproducible process performance measure, D2B time is weakly associated with the outcome of the interventional reperfusion strategy in acute STEMI. This measure should be associated with an outcome performance measure, such as the rate of TIMI 3 flow achieved by primary PCI, or replaced by the Door-to-TIMI 3 flow reperfusion time.
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Affiliation(s)
- J-L Georges
- Service de cardiologie, hôpital André-Mignot, Le-Chesnay cedex, France.
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Claret PG, Benezet JF, Cayla G, de La Coussaye JE. Les filières de soins au cours du syndrome coronarien aigu avec sus-décalage permanent du segment ST. ANNALES FRANCAISES DE MEDECINE D URGENCE 2011. [DOI: 10.1007/s13341-011-0128-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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[ST-segment elevation acute coronary syndromes: Prehospital management strategies]. Ann Cardiol Angeiol (Paris) 2010; 59:329-34. [PMID: 21055723 DOI: 10.1016/j.ancard.2010.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Prehospital management of ST-segment elevation myocardial infarction is a complex issue. Many components are involved, beginning with information of the public on the symptoms of heart attack, up to the choice of the final pathway and destination of the patients, with many intermediate steps including the regulation of emergency calls, the implementation of optimal diagnostic strategies, the choice of reperfusion therapy and of adjuvant medications. In recent years, optimization of these different components has led to improved patients' outcomes in this still life-threatening condition.
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