1
|
Al-Bawardy R, Alqarawi W, Al Suwaidi J, Almahmeed W, Zubaid M, Amin H, Sulaiman K, Al-Motarreb A, Alhabib K. The Effect of Beta-Blocker Post-Myocardial Infarction With Ejection Fraction >40% Pooled Analysis From Seven Arabian Gulf Acute Coronary Syndrome Registries. Angiology 2024:33197241227025. [PMID: 38227549 DOI: 10.1177/00033197241227025] [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: 01/17/2024]
Abstract
The use of beta-blockers (BB) in reduced left ventricular ejection fraction (LVEF) post-myocardial infarction (MI) is associated with reduced 1-year mortality, while their role in patients with mid-range and preserved LVEF post-MI remains controversial. We studied 31,620 patients who presented with acute coronary syndrome (ACS) enrolled in seven Arabian Gulf registries between 2005 and 2017. Patients with LVEF ≤40% were excluded. The remaining cohort was divided into two groups: BB group (n = 15,541) and non-BB group (n = 2,798), based on discharge medications. Patients in the non-BB group were relatively younger (55.3 vs. 57.4, P = .004) but higher risk at presentation; with higher Global Registry of Acute Coronary Events (GRACE) score (119.2 vs 109.2, P < .001), higher percentage of cardiogenic shock (3.5 vs 1.4%, P < .001), despite lower prevalence of comorbidities, such as hypertension and hyperlipidemia. BB use was associated with lower 1-year mortality in a multivariate logistic regression analysis, adjusting for major confounders [adjusted odds ratio (OR): 0.71 (95% CI 0.51-0.99)]. This remained the case in a sensitivity analysis using propensity score matching [adjusted OR: 0.34 (95% CI 0.16-0.73)]. In this study, using Arabian Gulf countries registries, the use of BB after ACS with LVEF >40% was independently associated with lower 1-year mortality.
Collapse
Affiliation(s)
- Rasha Al-Bawardy
- King Faisal Cardiac Center, Jeddah, Saudi Arabia
- King Saud Bin AbdulAziz University, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Wael Alqarawi
- Department of Cardiac Sciences, College of Medicine, King Saud University Medical City, King Saud University, King Fahad Cardiac Center, Riyadh, Saudi Arabia
| | | | - Wael Almahmeed
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Haitham Amin
- Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Bahrain
| | | | - Ahmad Al-Motarreb
- Cardiac Department, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Khalid Alhabib
- Department of Cardiac Sciences, College of Medicine, King Saud University Medical City, King Saud University, King Fahad Cardiac Center, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Al Saleh A, Jamee A, Sulaiman K, Sobhy M, Gamra H, Alkindi F, Benkhedda S, Al-Motarreb A, Amin MI, Almahmeed W, Hammoudeh A, Skouri H, Farhan HA, Al Jarallah M, Fellat N, Panduranga P, Alnajm BK, Abdelhamid M, Refaat R, Amor H, Messaous S, Ahmed HS, Chibane A, AbdulMalek A, Alsagheer NK, Dada S, Mokhtar Z, Ali M, Ullah A, AlBackr H, Alhabib KF. Clinical features, socioeconomic status, management, short and long-term outcomes of patients with acute myocardial infarction: Phase I results of PEACE MENA registry. PLoS One 2024; 19:e0296056. [PMID: 38206951 PMCID: PMC10783754 DOI: 10.1371/journal.pone.0296056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The Program for the Evaluation and Management of Cardiac Events in the Middle East and North Africa (PEACE MENA) is a prospective registry program in Arabian countries that involves in patients with acute myocardial infarction (AMI) or acute heart failure (AHF). METHODS This prospective, multi-center, multi-country study is the first report of the baseline characteristics and outcomes of inpatients with AMI who were enrolled during the first 14-month recruitment phase. We report the clinical characteristics, socioeconomic, educational levels, and management, in-hospital, one month and one-year outcomes. RESULTS Between April 2019 and June 2020, 1377 patients with AMI were enrolled (79.1% males) from 16 Arabian countries. The mean age (± SD) was 58 ± 12 years. Almost half of the population had a net income < $500/month, and 40% had limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia; 53% had STEMI, and almost half (49.7%) underwent a primary percutaneous intervention (PCI) (lowest 4.5% and highest 100%). Thrombolytics were used by 36.2%. (Lowest 6.45% and highest (90.9%). No reperfusion occurred in 13.8% of patients (lowest was 0% and highest 72.7%).Primary PCI was performed less frequently in the lower income group vs. high income group (26.3% vs. 54.7%; P<0.001). Recurrent ischemia occurred more frequently in the low-income group (10.9% vs. 7%; P = 0.018). Re-admission occurred in 9% at 1 month and 30% at 1 year, whereas 1-month mortality was 0.7% and 1-year mortality 4.7%. CONCLUSION In the MENA region, patients with AMI present at a young age and have a high burden of cardiac risk factors. Most of the patients in the registry have a low income and low educational status. There is heterogeneity among key performance indicators of AMI management among various Arabian countries.
Collapse
Affiliation(s)
- Ayman Al Saleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Amal Jamee
- Nassar Medical Complex Hospital, Ministry of Health, Khan Younes, Gaza Strip, Palestine
- Al-Quds Hospital, Gaza, Palestine
| | | | - Mohamed Sobhy
- International Cardiac Center (ICC), Alexandria, Egypt
| | - Habib Gamra
- Research Laboratory LR, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Fahad Alkindi
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Salim Benkhedda
- Cardiology Department, Mustapha Hospital, COCRG Laboratory University Benyoucef Benkhedda, Algiers, Algeria
| | | | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirate
| | | | - Hadi Skouri
- Cardiology Division, Internal Medicine Department at American University of Beirut Medical Center, Beirut, Lebanon
| | - Hasan A. Farhan
- Iraqi Board for Medical Specializations, Scientific Council of Cardiology. Baghdad Heart Center, Medical City, Baghdad, Iraq
| | | | | | | | | | - Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Giza Governorate, Egypt
| | - Rafik Refaat
- International Cardiac Center (ICC), Alexandria, Egypt
| | - Hassen Amor
- Taher Sfar University Hospital, Mahdia, Tunisia
| | - Salma Messaous
- Research Laboratory LR, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | | | - Ahcene Chibane
- Internal Medicine and Cardiology Department, CHU Douéra, Algiers, University Saad Dahlab, Blida, Algeria
| | - Azzouz AbdulMalek
- Cardiology Department, Mustapha Hospital, COCRG Laboratory University Benyoucef Benkhedda, Algiers, Algeria
| | | | - Sobhi Dada
- Hammoud University Medical Center, Saida, Lebanon
| | - Zaki Mokhtar
- King Saud Hospital, Unizah, Qaseem, Saudi Arabia
| | | | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Hanan AlBackr
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Manla Y, Almahmeed W. The Pandemic of Coronary Heart Disease in the Middle East and North Africa: What Clinicians Need to Know. Curr Atheroscler Rep 2023; 25:543-557. [PMID: 37615785 PMCID: PMC10471667 DOI: 10.1007/s11883-023-01126-x] [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] [Accepted: 06/23/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW Coronary heart disease (CHD) is the leading cause of morbidity, mortality, and disability in the Middle East and North Africa (MENA). While the prevention, diagnosis, and management of CHD have been detailed in international guidelines, we aimed in this review to quantify the pandemic of CHD in the MENA region and highlight regional patient characteristics, clinical challenges, and future directions to optimize CHD care in the region. RECENT FINDINGS Patients with CHD in the MENA feature younger age at presentation and worse prognosis in women. Despite the high burden of CHD risk factors, many of these factors remain underrecognized, undertreated, and uncontrolled. Additionally, CHD care is hampered by poor patient awareness, inefficient preventive strategies, and limited access to guideline-recommended therapeutics. All stakeholders involved in healthcare should work together to develop and execute strategies aimed at tackling the burden of CHD in the MENA.
Collapse
Affiliation(s)
- Yosef Manla
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Wael Almahmeed
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| |
Collapse
|
4
|
Alsaeed AH, Hersi A, Kashour T, Zubaid M, Al Suwaidi J, Amin H, AlMahmeed W, Sulaiman K, Al-Motarreb A, Alhabib KF, Alqarawi W. Characteristics and predictors of out-of-hospital cardiac arrest in young adults hospitalized with acute coronary syndrome: A retrospective cohort study of 30,000 patients in the Gulf region. PLoS One 2023; 18:e0286084. [PMID: 37228068 DOI: 10.1371/journal.pone.0286084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION The characteristics of young adults with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome (ACS) has not been well described. The mean age of gulf citizens in ACS registries is 10-15 years younger than their western counterparts, which provided us with a unique opportunity to investigate the characteristics and predictors of OHCA in young adults presenting with ACS. METHODOLOGY This was a retrospective cohort study using data from 7 prospective ACS registries in the Gulf region. In brief, all registries included consecutive adults who were admitted with ACS. OHCA was defined as cardiac arrest upon presentation (i.e., before admission to the hospital). We described the characteristics of young adults (< 50 years) who had OHCA and performed multivariate logistic regression analysis to assess independent predictors of OHCA. RESULTS A total of 31,620 ACS patients were included in the study. There were 611 (1.93%) OHCA cases in the whole cohort [188/10,848 (1.73%) in young adults vs 423/20,772 (2.04%) in older adults, p = 0.06]. Young adults were predominantly males presenting with ST-elevation myocardial infarction (STEMI) [182/188 (96.8%) and 172/188 (91.49%), respectively]. OHCA was the sentinel event of coronary artery disease (CAD) in 70% of young adults. STEMI, male sex, and non-smoking status were found to be independent predictors of OHCA [OR = 5.862 (95% CI 2.623-13.096), OR: 4.515 (95% CI 1.085-18.786), and OR = 2.27 (95% CI 1.335-3.86), respectively]. CONCLUSION We observed a lower prevalence of OHCA in ACS patients in our region as compared to previous literature from other regions. Moreover, OHCA was the sentinel event of CAD in the majority of young adults, who were predominantly males with STEMIs. These findings should help risk-stratify patients with ACS and inform further research into the characteristics of OHCA in young adults.
Collapse
Affiliation(s)
- Abdulelah H Alsaeed
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Hersi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tarek Kashour
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Centre, Awali, Bahrain
| | - Wael AlMahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | | | - Ahmed Al-Motarreb
- Internal Medicine Department, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Khalid F Alhabib
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wael Alqarawi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
5
|
Use of emergency medical service in acute myocardial infarction in an Italian Northeastern region. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01422-9] [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] Open
|
6
|
Muraleedharan M, Chandak AO. Developing a conceptual model for studying various points of delays and underlying factors in the emergency healthcare system. EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To review various literature related to emergency healthcarerelated delays and synthesize a conceptual framework for future research. Critical Interpretative Synthesis is employed to analyze and develop themes from selected articles. A total of 25 articles were selected for analysis after the careful selection process. Diseases including acute heart disease, stroke, pneumonia, infections, and gastrointestinal disorders were included. During analysis, three major phases of delays emerged: pre-hospital delay, inhospital delay, and ambulance off-load delay. Various factors, including socioeconomic factors, health system factors, organizational level factors, etc., are related to delays in emergency care settings. The model evolved from this literature analysis is similar to the 3 delays model. This review identified three significant delay segments related to emergency health care management.
Collapse
|
7
|
Shaheen S, Wafa A, Mokarab M, Zareef B, Bendary A, Abdelhameed T, Rashwan A, Seleem M, Elmasry M, Abdelhady Y, Abdelrazik G, Ibrahim A, Ghareeb M, Aly K, Saraya M, Wadie M, Youssef M. Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction. Egypt Heart J 2020; 72:35. [PMID: 32607863 PMCID: PMC7326745 DOI: 10.1186/s43044-020-00069-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Apart from few small single-center studies, there are limited data about STEMI patients in Egypt. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. The aims of this study were to describe the characteristics of patients with STEMI, to assess STEMI management patterns particularly the current use of reperfusion therapies, to evaluate the organization of STEMI networks across Egypt, to evaluate in-hospital patient outcome, and to compare Egyptian patients with other ESC countries.
Results
Compared to other ESC countries, Egyptian patients were younger (mean age 55.4 ± 11.3 vs. 62.9 ± 12.4; p < 0.001 and 4.36% vs. 19.41%% were ≥ 75 years old; p < 0.001) with fewer females (18.44% vs. 25.63%; p < 0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs.100.0 (50.0; 240.0) p < 0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.06% in Egypt vs. 25.83% in EU countries (p < 0.001). On qualifying ECG, anterior STEMI was in 57.08% in Egypt vs. 45.98% in other countries (p < 0.001). Initial reperfusion therapy was 49.12%, 43.07%, and 7.26% for primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.42%, 7.26%, and 7.82% for EU countries, respectively. In-hospital mortality was 4.65% in Egypt vs. 3.50% in other countries p 0.040 and was 18.87% in no reperfusion vs. 2.10% in primary PCI vs. 4.97% in thrombolysis (p < 0.001) among Egyptians. Patients were discharged on aspirin in 98.61%, clopidogrel in 91.07%, ticagrelor in 7.31%, DAPT in 97.69%, beta blockers in 82.83%, ACE inhibitors in 84.76%, MRAs in 10.01%, and statins in 99.77%.
Conclusion
Compared to other ESC countries, Egyptian STEMI patients were younger, more frequently current smokers and diabetics, and had longer time between symptoms onset and first medical contact with more self-presentation rather than EMS presentation. Thrombolytic therapy is still a common reperfusion therapy in Egypt while primary PCI was offered to half of the patients. In-hospital mortality was significantly higher in Egypt and was highest among no reperfusion patients and lowest among PPCI patients.
Collapse
|
8
|
Khaled S, Ahmed WE, Shalaby G, Alqasimi H, Ruzaizah RA, Haddad M, Alsabri M, Almalki S, Kufiah H, Aboul Elnein F, Jaha N. Disparities of demographics, clinical characteristics, and hospital outcomes of AMI pilgrims vs non-pilgrims—tertiary center experience. Egypt Heart J 2020; 72:31. [PMID: 32472304 PMCID: PMC7260330 DOI: 10.1186/s43044-020-00068-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/15/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute myocardial infarction (AMI) is usually caused by rupture of an atherosclerotic plaque leading to thrombotic occlusion of a coronary artery. Cardiovascular disease has recently emerged as the leading cause of death during hajj. Our aim is to demonstrate the AMI pilgrim’s related disparities and comparing them to non-pilgrim patients.
Result
Out of 3044 of patients presented with AMI from January 2016 to August 2019, 1008 (33%) were pilgrims. They were older in age (P < 0.001) and showed significantly lower rates cardiovascular risk factors (P < 0.001 for DM, smoking, and obesity). Pilgrims were also less likely to receive thrombolytic therapy (P < 0.001), show lower rate of late AMI presentation (P < 0.001), develop more LV dysfunction post AMI (P < 0.001), and have critical CAD anatomy in their coronary angiography (P < 0.001 for MVD and = 0.02 for LM disease) compared to non-pilgrim AMI patients. Despite AMI pilgrims recorded higher rate of primary percutaneous coronary intervention (PPCI) procedures, they still showed poor hospital outcomes (P < 0.001, 0.004, < 0.001, 0.05, and 0.001, respectively for pulmonary edema, cardiogenic shock, mechanical ventilation, cardiac arrest, and in-hospital mortality, respectively). Being a pilgrim and presence of significant left ventricular systolic dysfunction, post AMI was the two independent predictors of mortality among our studied patients (P = 0.005 and 0.001, respectively).
Conclusion
Although AMI pilgrims had less cardiovascular risk factors and they were early revascularized, they showed higher rates of post myocardial infarction complication and poor hospital outcomes. Implementation of pre-hajj screening, awareness and education programs, and primary and secondary preventive measures should be taken in to consideration to improve AMI pilgrim’s outcome.
Collapse
|
9
|
Kinsara AJ, Alsaleh A, Taher ZA, Alshamiri M, Elshaer F. The Primary Management Strategies for ST-Elevation Myocardial Infarction Patients in Saudi Arabia: A Sub-Study of the Saudi Acute Myocardial Infarction Registry. Cureus 2020; 12:e11783. [PMID: 33409030 PMCID: PMC7779176 DOI: 10.7759/cureus.11783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and objective Not all patients with ST-elevation myocardial infarction (STEMI) in Saudi Arabia are managed with a primary percutaneous coronary intervention (PPCI). We analyzed the management strategies for STEMI patients in the Saudi Acute Myocardial Infarction Registry (STARS). The strategies include PPCI, revascularization with thrombolytic therapy, and conservative management. This study involved a sub-study of the STARS. Methods STEMI patients were categorized into three groups. Group 1 was managed with PPCI, group 2 with revascularization with thrombolytic therapy, and group 3 with conservative approaches. The data were collected at presentation, at one month, and at one year after discharge. Results The sample consisted of 1,471 patients. The mean age of the participants was 54 ±12 years; 51% were Saudi citizens, and the majority (89%) were male. Their background revealed a high coronary risk profile, with 48% diagnosed with diabetes mellitus (DM) and 44% with hypertension (HTN); 54% were active or ex-smokers, 30% had a high lipid profile, and 74% were overweight. PPCI was performed in 42%, and 29% were managed with revascularization using thrombolytic therapy. A conservative approach was followed in 29% of the patients. Patients who had a stroke were treated conservatively due to the risk of bleeding. The patients in group 1 were mostly hypertensive with recurrent angina and a history of prior revascularization, with PPCI or coronary artery bypass grafting (CABG). The crude all-cause mortality at one year was 11%; it was 7% at one month for group 1, 8% for group 2, and 9% for group 3, which was not statistically significant. Conclusions Controlling the risk factors and improving access to PPCI in hospitals are fundamental in the management of STEMI patients. PPCI is still underused. Guideline-directed medical therapy (GDMT) is a reasonable approach if PPCI is not available.
Collapse
Affiliation(s)
- Abdulhalim J Kinsara
- Cardiology, Ministry of National Guard - Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, COM-WR, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ayman Alsaleh
- Cardiology, Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, SAU
| | - Ziad A Taher
- Internal Medicine, Department of Medicine, Ministry of National Guard - Health Affairs, Jeddah, SAU.,Internal Medicine, Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mostafa Alshamiri
- Cardiology, Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, SAU
| | - Fayez Elshaer
- Cardiology, Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, SAU
| |
Collapse
|
10
|
Ginanjar E, Sjaaf AC, Alwi I, Sulistyadi W, Suryadarmawan E, Wibowo A, Liastuti LD. CODE STEMI Program Improves Clinical Outcome in ST Elevation Myocardial Infarction Patients: A Retrospective Cohort Study. Open Access Emerg Med 2020; 12:315-321. [PMID: 33173358 PMCID: PMC7646377 DOI: 10.2147/oaem.s259155] [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: 04/21/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose One of the most frequent causes of cardiac mortality is ST elevation myocardial infarction (STEMI). Delay in the management of STEMI patients is a cause of high mortality and morbidity. This study aims to determine the effect of the implementation of the CODE STEMI program on major adverse cardiac events (MACE) and mortality of STEMI patients at Dr. Cipto Mangunkusumo General Hospital. Patients and Methods This was a retrospective cohort study that enrolled 207 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) in 2015–2018. The patients were divided into two groups. The first group was treated prior to establishing the CODE STEMI program. The other group was treated according to the program, which was implemented in January 2017. Data were collected from medical records, and we retrospectively analyzed all in-hours, MACE, and mortality of STEMI patients from both groups as primary outcomes. Data analysis was done using the Mann–Whitney and chi-square test. Results There were 72 and 135 patients in the pre‐CODE STEMI and CODE STEMI groups, respectively. D2BT was significantly reduced by 130 min (288±306 vs 158±81, P< 0.001) since the implementation of CODE STEMI program. There were trends to lower in-hospital mortality rates (8.3% vs 4.4%, RR = 0.53) and MACE at 30 days (48.61% vs 37.78%, RR = 0.77). Conclusion Implementation of the CODE STEMI program can reduce door-to-balloon time and decrease the MACE and mortality rate in STEMI patients in general hospitals.
Collapse
Affiliation(s)
- Eka Ginanjar
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Amal C Sjaaf
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Idrus Alwi
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Wahyu Sulistyadi
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Ede Suryadarmawan
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Adik Wibowo
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Lies Dina Liastuti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
11
|
Alkamel N, Jamal A, Alnobani O, Househ M, Zakaria N, Qawasmeh M, Tharkar S. Understanding the stakeholders' preferences on a mobile application to reduce door to balloon time in the management of ST-elevated myocardial infarction patients - a qualitative study. BMC Med Inform Decis Mak 2020; 20:205. [PMID: 32867749 PMCID: PMC7457529 DOI: 10.1186/s12911-020-01219-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/13/2020] [Indexed: 12/02/2022] Open
Abstract
Background ST-elevated myocardial infarction (STEMI) is a critical and time-sensitive emergency. The survival depends on prompt initiation of treatment requiring high precision and multi-level coordination between healthcare staff. The use of a mobile application may facilitate prompt management and shorten the door-to-balloon time by capturing information at the point of care and provide immediate feedback to all healthcare staff involved in STEMI management. The objective of the present study has two primary components: (i) to explore the suggestions and opinions of stakeholders in the development of a novel mobile app for code activation in management of STEMI patients (ii) to find out the healthcare workers’ expectations including facilitating steps and challenges in the activation process of the proposed mobile app. Methods Unstructured interviews were conducted with key informants (n = 2) to identify all stakeholders, who also helped in developing the interview protocol and prototype designs. In-depth, semi-structured, open-ended, face to face interviews were conducted on 22 stakeholders involved in managing STEMI patients. All interviews were recorded and transcribed verbatim. Data were analyzed using ATLAS.ti 8 software, allowing themes and subthemes to emerge. Results The 22 participants included in the study were cardiology physicians (n = 3), emergency consultants (n = 4), emergency room (ER) senior nurses (n = 10), and cardiac catheterization lab staff (n = 5). The main themes identified during analysis were workflow and the App. The themes identified from the interviews surrounding the App were: 1) facilitating ideas 2) management steps needed 3) features 4) preferred code activation method 5) steps of integration 6) possible benefits of the App 7) barriers and 8) possible solutions to the suggested barriers. Most of the interviewed stakeholders expressed their acceptance after viewing the proposed mobile app prototype. Conclusion The study identified the mandatory features and the management steps needed from the stakeholder’s perspectives. The steps for integrating the current paper-based workflow with the suggested mobile app were identified. The expected benefits of the App may include improved and faster management, accuracy, better communication, and improvement in data quality. Moreover, the possible barriers might comprise of doubtful acceptability, device-related issues, and time and data-related challenges.
Collapse
Affiliation(s)
- Nour Alkamel
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amr Jamal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia. .,Evidence-Based Healthcare and Knowledge Translation Research Chair, King Saud University, PO Box 90714, Riyadh, 11623, Saudi Arabia.
| | - Omar Alnobani
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mowafa Househ
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Nasriah Zakaria
- Medical Education Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Qawasmeh
- Nursing Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Shabana Tharkar
- Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Alhabib KF, Gamra H, Almahmeed W, Hammoudeh A, Benkheddah S, Al Jarallah M, Al-Motarreb A, Alquraishi M, Sobhy M, Yousif MG, Alkindi F, Fellat N, Amin MI, Ali M, Al Saleh A, Ullah A, Zannad F. Acute myocardial infarction and acute heart failure in the Middle East and North Africa: Study design and pilot phase study results from the PEACE MENA registry. PLoS One 2020; 15:e0236292. [PMID: 32697793 PMCID: PMC7375595 DOI: 10.1371/journal.pone.0236292] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/01/2020] [Indexed: 12/28/2022] Open
Abstract
Background This pilot study describes the overall design and results of the Program for the Evaluation and Management of the Cardiac Events registry for the Middle East and North Africa (MENA) Region. Methods This prospective, multi-center, multi-country study included patients hospitalized with acute myocardial infarction (AMI) and/or acute heart failure (AHF). We evaluated the clinical characteristics, socioeconomic and educational levels, management, in-hospital outcomes, and 30-day mortality rate of patients that were admitted to one tertiary-care center in each of 14 Arab countries in the MENA region. Results Between 22 April and 28 August 2018, 543 AMI and 381AHF patients were enrolled from 14 Arab countries (mean age, 57±12 years, 82.5% men). Over half of the patients in both study groups had low incomes with limited health care coverage, and limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia. Among patients with ST-elevation myocardial infarctions, 56.4% received primary percutaneous interventions, 24% received thrombolysis, and 19.5% received no acute reperfusion therapy. The main causes of AHF were ischemic heart diseases (55%) and primary valvular heart diseases (15%). The in-hospital and 30-day mortality rates were 2.0% and 3.5%, respectively, for AMI, and 5.4% and 7.0%, respectively, for AHF. Conclusions This pilot study revealed a high prevalence of cardiovascular risk factors in patients with AMI and AHF in Arab countries, and low levels of socioeconomic and educational status. Future phases of the study will improve our understanding of the impact that these factors have on the management and outcomes of cardiac events in these patient populations.
Collapse
Affiliation(s)
- Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- * E-mail:
| | - Habib Gamra
- Research Laboratory LR 12SP16, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirate
| | | | - Salim Benkheddah
- Cardiology Department, Mustapha Hospital, University Benyoucef Benkhedda, Alger Ctre, Algeria
| | | | | | | | - Mohamed Sobhy
- International Cardiac Center (ICC), Alexandria, Egypt
| | | | - Fahad Alkindi
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Ayman Al Saleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faiez Zannad
- Centre d'Investigation Clinique Inserm, Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine, CHU, Nancy, France
| |
Collapse
|
13
|
Shehab A, AlHabib KF, Bhagavathula AS, Hersi A, Alfaleh H, Alshamiri MQ, Ullah A, Sulaiman K, Almahmeed W, Al Suwaidi J, Alsheikh-Ali AA, Amin H, Al Jarallah M, Salam AM. Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries. Curr Vasc Pharmacol 2020. [PMID: 29542414 DOI: 10.2174/1570161116666180315104820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. AIMS To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. METHODS Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. RESULTS Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). CONCLUSION Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.
Collapse
Affiliation(s)
- Abdulla Shehab
- Internal Medicine Department, College of Medicine and Health Sciences (CMHS), UAE University, Al Ain, United Arab Emirates
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Akshaya S Bhagavathula
- Department of Clinical Pharmacy, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Ahmad Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Hussam Alfaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Mostafa Q Alshamiri
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Alwai A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.,Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.,Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA, United States
| | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain
| | | | - Amar M Salam
- Adult Cardiology, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
14
|
Abuzeyad FH, Al Qasim G, Alqasem L, Al Farras MI. Evolution of emergency medical services in the Kingdom of Bahrain. Int J Emerg Med 2020; 13:20. [PMID: 32345212 PMCID: PMC7189519 DOI: 10.1186/s12245-020-00280-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/14/2020] [Indexed: 01/31/2023] Open
Abstract
Emergency medical services (EMS) is crucial to any healthcare system, especially in urban countries. The Kingdom of Bahrain has always strived to develop healthcare services throughout the Kingdom including EMS. Like any other country, the Kingdom has gone through several stages in the provision of EMS. This article will focus on the development of EMS in the Kingdom and its evolution from a scattered hospital-based system to a unified system, which ensures ease of access for the population and speed of delivery to the healthcare facilities. The major focus will be the most recent national project which is the National Ambulance.
Collapse
Affiliation(s)
- Feras H Abuzeyad
- Department of Emergency Medicine, King Hamad University Hospital, Building 2345, Road 2835, Block 228, P. O. Box 24343, Busaiteen, Kingdom of Bahrain
| | - Ghada Al Qasim
- Emergency Medicine Department, Bahrain Defence Force, Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Leena Alqasem
- National Health Regulatory Authority, Sanabis, Kingdom of Bahrain
| | - Mudhaffar I Al Farras
- Department of Emergency Medicine, King Hamad University Hospital, Building 2345, Road 2835, Block 228, P. O. Box 24343, Busaiteen, Kingdom of Bahrain.
| |
Collapse
|
15
|
Shehab A, Bhagavathula AS, Alhabib KF, Ullah A, Suwaidi JA, Almahmeed W, AlFaleh H, Zubaid M. Age-Related Sex Differences in Clinical Presentation, Management, and Outcomes in ST-Segment-Elevation Myocardial Infarction: Pooled Analysis of 15 532 Patients From 7 Arabian Gulf Registries. J Am Heart Assoc 2020; 9:e013880. [PMID: 32063127 PMCID: PMC7070221 DOI: 10.1161/jaha.119.013880] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background No studies from the Arabian Gulf region have taken age into account when examining sex differences in ST-segment-elevation myocardial infarction (STEMI) presentation and outcomes. We examined the relationship between sex differences and presenting characteristics, revascularization procedures, and in-hospital mortality after accounting for age in patients hospitalized with STEMI in the Arabian Gulf region from 2005 to 2017. Methods and Results This study was a pooled analysis of 31 620 patients with a diagnosis of acute coronary syndrome enrolled in 7 Arabian Gulf registries. Of these, 15 532 patients aged ≥18 years were hospitalized with a primary diagnosis of STEMI. A multiple variable regression model was used to assess sex differences in revascularization, in-hospital mortality, and 1-year mortality. Odds ratios and 95% CIs were calculated. Women were, on average, 8.5 years older than men (mean age: 61.7 versus 53.2 years; absolute standard mean difference: 68.9%). The age-stratified analysis showed that younger women (aged <65 years) with STEMI were more likely to seek acute medical care and were less likely to receive thrombolytic therapies or primary percutaneous coronary intervention and guideline-recommended pharmacotherapy than men. Women had higher crude in-hospital mortality than men, driven mainly by younger age (46-55 years, odds ratio: 2.60 [95% CI, 1.80-3.7]; P<0.001; 56-65 years, odds ratio: 2.32 [95% CI, 1.75-3.08]; P<0.001; and 66-75 years, odds ratio: 1.79 [95% CI, 1.33-2.41]; P<0.001). Younger women had higher adjusted in-hospital and 1-year mortality rates than younger men (P<0.001). Conclusions Younger women (aged ≤65 years) with STEMI were less likely to receive guideline-recommended pharmacotherapy and revascularization than younger men during hospitalization and had higher in-hospital and 1-year mortality rates.
Collapse
Affiliation(s)
- Abdulla Shehab
- Department of internal medicine College of Medicine and Health Sciences UAE University Al Ain Abu Dhabi United Arab Emirates
| | - Akshaya Srikanth Bhagavathula
- Department of internal medicine College of Medicine and Health Sciences UAE University Al Ain Abu Dhabi United Arab Emirates
| | - Khalid F Alhabib
- Department of Clinical Sciences College of Medicine King Saud University Riyadh Saudi Arabia
| | - Anhar Ullah
- Department of Clinical Sciences College of Medicine King Saud University Riyadh Saudi Arabia
| | - Jassim Al Suwaidi
- Department of Cardiology and Cardiovascular Surgery Hamad Medical Corporation (HMC) Doha Qatar
| | - Wael Almahmeed
- Cardiology Heart & Vascular Institute Cleveland Clinic Abu Dhabi United Arab Emirates
| | - Hussam AlFaleh
- Department of Clinical Sciences College of Medicine King Saud University Riyadh Saudi Arabia
| | - Mohammad Zubaid
- Department of Medicine Faculty of Medicine Kuwait University Kuwait
| |
Collapse
|
16
|
Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry. Ann Glob Health 2020; 86:13. [PMID: 32064231 PMCID: PMC7006601 DOI: 10.5334/aogh.2632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: A pharmacoinvasive reperfusion strategy is recommended for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (PCI) cannot be achieved in a timely fashion. This is based on a limited number of trials. The effectiveness of this strategy in the real-world is unclear. Objectives: To compare the effectiveness of pharmacoinvasive strategy versus primary PCI using a nationwide prospective registry of STEMI patients. Methods: We examined 936 STEMI patients from the reperfusion in ST-elevation myocardial infarction in Kuwait (REPERFUSE Kuwait) registry who underwent either primary PCI or pharmacoinvasive reperfusion. A composite outcome was measured based on death, congestive heart failure, reinfarction or stroke prospectively ascertained during hospital stay and up to one-year follow-up. The association between reperfusion strategy and the composite outcome was assessed using multivariate regression and Poisson proportional hazard model. Results: Compared to the pharmacoinvasive group, those undergoing primary PCI had higher Killip class on presentation and required more blood transfusions during hospitalization. There was no significant difference between primary PCI and pharmacoinvasive strategy with regards to the incidence of the composite outcome during the in-hospital period (RR = 1.0; 95% CI 0.98–1.02; p = 0.96) after adjustment for possible confounders. Over one-year follow-up, the survival of the two groups was not different (p = 0.66). The incidence of major bleeding was similar in both groups. Conclusion: STEMI patients treated with a pharmacoinvasive strategy have comparable outcomes to those treated with primary PCI with no increased risk of major bleeding. These real-world data support the use of a pharmacoinvasive strategy when primary PCI cannot be achieved in a timely fashion.
Collapse
|
17
|
Lee SH, Kim HK, Jeong MH, Lee JM, Gwon HC, Chae SC, Seong IW, Park JS, Chae JK, Hur SH, Cha KS, Kim HS, Seung KB, Rha SW, Ahn TH, Kim CJ, Hwang JY, Choi DJ, Yoon J, Joo SJ, Hwang KK, Kim DI, Oh SK. Pre-hospital delay and emergency medical services in acute myocardial infarction. Korean J Intern Med 2020; 35:119-132. [PMID: 31766823 PMCID: PMC6960059 DOI: 10.3904/kjim.2019.123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/19/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Minimising total ischemic time (TIT) is important for improving clinical outcomes in patients with ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention (PCI). TIT has not shown a significant improvement due to persistent pre-hospital delay. This study aimed to investigate the risk factors associated with pre-hospital delay. METHODS Individuals enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health between 2011 and 2015 were included in this study. The study population was analyzed according to the symptom-to-door time (STDT; within 60 or > 60 minutes), and according to the type of hospital visit (emergency medical services [EMS], non-PCI center, or PCI center). RESULTS A total of 4,874 patients were included in the analysis, of whom 28.4% arrived at the hospital within 60 minutes of symptom-onset. Old age (> 65 years), female gender, and renewed ischemia were independent predictors of delayed STDT. Utilising EMS was the only factor shown to reduce STDT within 60 minutes, even when cardiogenic shock was evident. The overall frequency of EMS utilisation was low (21.7%). Female gender was associated with not utilising EMS, whereas cardiogenic shock, previous myocardial infarction, familial history of ischemic heart disease, and off-hour visits were associated with utilising EMS. CONCLUSION Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.
Collapse
Affiliation(s)
- Seung Hun Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Kuk Kim
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Correspondence to Myung Ho Jeong, M.D. Department of Cardiology, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju 61469, Korea Tel: +82-62-220-6243, Fax: +82-62-228-7174, E-mail:
| | - Joo Myung Lee
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - In-Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jong-Seon Park
- Division of Cardiology, Yeungnam University Medical Centre, Daegu, Korea
| | - Jei Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Seung-Ho Hur
- Department of Cardiovascular Medicine, Keimyung University Dongsan Medical Centre, Daegu, Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Hyo-Soo Kim
- Cardiovascular Centre, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Centre, Korea University Guro Hospital, Seoul, Korea
| | - Tae Hoon Ahn
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Chong-Jin Kim
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong-Ju Choi
- Cardiovascular Centre, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Doo-Il Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Seok Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | | |
Collapse
|
18
|
Moafa HN, van Kuijk SMJ, Franssen GHLM, Moukhyer ME, Haak HR. What is known about the quality of out-of-hospital emergency medical services in the Arabian Gulf States? A systematic review. PLoS One 2019; 14:e0226230. [PMID: 31856219 PMCID: PMC6922377 DOI: 10.1371/journal.pone.0226230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Emergency Medical Services (EMS) have been developed in the Arabian Gulf States (AGS) in the last three decades. The EMS needs continuous quality assessment of their performance to improve and provide the best out-of-hospital care. This study aims to assess the quality of EMS in the AGS according to the six quality domains of the Institute of Medicine. METHODS We searched four databases (i.e., PubMed, EMBASE, Web of Science, and CINAHL) for studies that reported on the quality of EMS in any of the AGS using clinical or non-clinical performance indicators. To quantify study quality and risk of bias, the adapted Newcastle Ottawa Scale was used. We focused on structural and functional indicators, clinical and non-clinical. RESULTS Twenty-five studies were eligible for inclusion. One study contained result of safety, fifteen time-centeredness, twenty effectiveness, five patient-centeredness, and thirteen studies reported on equity of EMS. None of the studies reported on efficiency of EMS. A significant proportion of studies showed high scores on the Newcastle-Ottawa scale. Limited studies on EMS quality were available, not covering all relevant quality domains and not covering the whole AGS region. The equity domain showed the best outcome performance finding, whereas finding of the patient-centeredness domain showed room for improvement in the foreseeable future. CONCLUSION This review highlights the need for more and better studies of sufficient quality about all domains of quality in EMS in all the AGS. EMS research in Kuwait and Bahrain is warranted, as currently studies of EMS quality are unavailable for these States. Moreover, efficiency researches exploring this discipline should be conducted specially no studies were found has been searching this domain. TRIAL REGISTRATION PROSPERO registration number: CRD42019123896.
Collapse
Affiliation(s)
- H. N. Moafa
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - S. M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - M. E. Moukhyer
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - H. R. Haak
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maxima Medisch Centre, Eindhoven, The Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
19
|
El-Menyar A, Al Habib KF, Zubaid M, Alsheikh-Ali AA, Sulaiman K, Almahmeed W, Amin H, AlMotarreb A, Ullah A, Suwaidi JA. Utility of shock index in 24,636 patients presenting with acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:546-556. [PMID: 31702396 DOI: 10.1177/2048872619886307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Shock index is a bedside reflection of integrated response of the cardiovascular and nervous systems. We aimed to evaluate the utility of shock index (heart rate/systolic blood pressure) in patients presenting with acute coronary syndrome (ACS). METHODS We analyzed pooled data from seven Arabian Gulf registries; these ACS registries were carried out in seven countries (Qatar, Bahrain, Kuwait, UAE, Saudi Arabia, Oman and Yemen) between 2005 and 2017. A standard uniform coding strategy was used to recode each database using each registry protocol and clinical research form. Patients were categorized into two groups based on their initial shock index (low vs. high shock index). Optimal shock index cutoff was determined according to the receiver operating characteristic curve (ROC). Primary outcome was hospital mortality. RESULTS A total of 24,636 ACS patients met the inclusion criteria with a mean age 57±13 years. Based on ROC analysis, the optimal shock index was 0.80 (83.5% had shock index <0.80 and 16.5% had shock index ≥0.80). In patients with high shock index, 55% had ST-elevation myocardial infarction and 45% had non-ST-elevation myocardial infarction. Patients with high shock index were more likely to have diabetes mellitus, late presentation, door to electrocardiogram >10 min, symptom to Emergency Department > 3 h, anterior myocardial infarction, impaired left ventricular function, no reperfusion post-therapy, recurrent ischemia/myocardial infarction, tachyarrhythmia and stroke. However, high shock index was associated significantly with less chest pain, less thrombolytic therapy and less primary percutaneous coronary intervention. Shock index correlated significantly with pulse pressure (r= -0.52), mean arterial pressure (r= -0.48), Global Registry of Acute Coronary Events score (r =0.41) and Thrombolysis In Myocardial Infarction simple risk index (r= -0.59). Shock index ≥0.80 predicted mortality in ACS with 49% sensitivity, 85% specificity, 97.6% negative predictive value and 0.6 negative likelihood ratio. Multivariate regression analysis showed that shock index was an independent predictor for in-hospital mortality (adjusted odds ratio (aOR) 3.40, p<0.001), heart failure (aOR 1.67, p<0.001) and cardiogenic shock (aOR 3.70, p<0.001). CONCLUSIONS Although shock index is the least accurate of the ones tested, its simplicity may argue in favor of its use for early risk stratification in patients with ACS. The utility of shock index is equally good for ST-elevation myocardial infarction and non-ST-elevation acute coronary syndrome. High shock index identifies patients at increased risk of in-hospital mortality and urges physicians in the Emergency Department to use aggressive management.
Collapse
Affiliation(s)
- Ayman El-Menyar
- Clinical Medicine, Weill Cornel Medical College, Doha, Qatar.,Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Khalid F Al Habib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, KSA
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed AlMotarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Yemen
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, KSA
| | - Jassim Al Suwaidi
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
20
|
Alhabib KF, Kinsara AJ, Alghamdi S, Al-Murayeh M, Hussein GA, AlSaif S, Khalaf H, Alfaleh H, Hersi A, Kashour T, Al-saleh A, Ali M, Ullah A, Mhish H, Abdo AN, Almutairi F, Arafah MR, AlKutshan R, Aldosari M, AlSabatien BY, Alrazzaz M, Maria AM, Aref AH, Selim MM, Morsy AM, AlTohari FA, Alrifai AA, Awaad AA, El-Sayed H, Mansour S, Atwa AA, Abdelkader S, Altamimi N, Saleh E, Alhaidari W, ElShihawy EHA, Busaleh AH, Abdalmoutaleb M, Fawzy EM, Mokhtar Z, Saleh AM, Ahmad MA, Almasswary A, Alshehri M, Abohatab KM, AlGarni T, Butt M, Altaj I, Abdullah F, Alhosni Y, Osman HB, Bugti N, Aziz AA, Alarabi A, AlHarbi IA. The first survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and long-term outcomes (STARS-1 Program). PLoS One 2019; 14:e0216551. [PMID: 31112586 PMCID: PMC6528983 DOI: 10.1371/journal.pone.0216551] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/23/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Prior acute coronary syndrome (ACS) registries in Saudi Arabia might not have accurately described the true demographics and cardiac care of patients with ACS. We aimed to evaluate the clinical characteristics, management, and outcomes of a representative sample of patients with acute myocardial infarction (AMI) in Saudi Arabia. METHODS We conducted a 1-month snap-shot, prospective, multi-center registry study in 50 hospitals from various health care sectors in Saudi Arabia. We followed patients for 1 month and 1 year after hospital discharge. Patients with AMI included those with or without ST-segment elevation (STEMI or NSTEMI, respectively). This program survey will be repeated every 5 years. RESULTS Between May 2015 and January 2017, we enrolled 2233 patients with ACS (mean age was 56 [standard deviation = 13] years; 55.6% were Saudi citizens, 85.7% were men, and 65.9% had STEMI). Coronary artery disease risk factors were high; 52.7% had diabetes mellitus and 51.2% had hypertension. Emergency Medical Services (EMS) was utilized in only 5.2% of cases. Revascularization for patients with STEMI included thrombolytic therapy (29%), primary percutaneous coronary intervention (PCI); (42.5%), neither (29%), or a pharmaco-invasive approach (3%). Non-Saudis with STEMI were less likely to undergo primary PCI compared to Saudis (35.8% vs. 48.7%; respectively, p <0.001), and women were less likely than men to achieve a door-to-balloon time of <90 min (42% vs. 65%; respectively, p = 0.003). Around half of the patients with NSTEMI did not undergo a coronary angiogram. All-cause mortality rates were 4%, 5.8%, and 8.1%, in-hospital, at 1 month, and at 1 year, respectively. These rates were significantly higher in women than in men. CONCLUSIONS There is an urgent need for primary prevention programs, improving the EMS infrastructure and utilization, and establishing organized ACS network programs. AMI care needs further improvement, particularly for women and non-Saudis.
Collapse
Affiliation(s)
- Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- * E-mail:
| | - Abdulhalim J. Kinsara
- Department of Cardiology, Ministry of National Guard Health Affair, King Saud bin Abdulaziz University for Health Sciences, COM-WR King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | | | | | | | - Hassan Khalaf
- Prince Sultan Cardiac Center, Buraydah City, Saudi Arabia
- Ha’il Cardiac Center, Hail, Saudi Arabia
| | - Hussam Alfaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayman Al-saleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hassan Mhish
- King Salman Heart Center, King Fahd Medical City, Riyadh, Saudi Arabia
| | | | | | | | | | - Mubarak Aldosari
- King Saud Medical City (Riyadh Medical Complex), Riyadh, Saudi Arabia
| | | | | | | | - Aziza H. Aref
- Imam Abdulrahman Al Faisal Hospital, Riyadh, Saudi Arabia
| | | | | | | | - Ammar A. Alrifai
- King Abdulaziz Hospital and Oncology Center, Jeddah, Saudi Arabia
| | | | | | | | | | | | | | | | | | | | | | | | - Essam M. Fawzy
- King Khalid General Hospital, Hafar Albatin, Saudi Arabia
| | | | - Adil M. Saleh
- Dr.Sulaiman Alhabib Hospital, Buraydah, Saudi Arabia
| | | | | | - Mohammed Alshehri
- Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | | | - Turki AlGarni
- Khamis Mushayt General Hospital, Khamis Mushayt, Saudi Arabia
| | - Modaser Butt
- King Khalid Civilian Hospital, Tabuk, Saudi Arabia
| | - Ibrahim Altaj
- Arar Cardiac Center (Prince Abdulla bin Abdulaziz bin Musaed Cardiac Center), Arar, Saudi Arabia
| | | | - Yahya Alhosni
- Prince Sultan Cardiac Center-King Khalid Hospital, Najran, Saudi Arabia
| | - Hadia B. Osman
- Prince Meteb Ibn Abdulaziz Hospital, Sakaka, Saudi Arabia
| | | | - Atif A. Aziz
- Dumat AlJandal Hospital, Dumat AlJandal, Saudi Arabia
| | | | | |
Collapse
|
21
|
Berwanger O, Abdelhamid M, Alexander T, Alzubaidi A, Averkov O, Aylward P, Contreras Zúñiga E, Halvorsen S, Iglesias R, A Sk Abdul Kader M, Zubaid M, AlHabib KF. Use of ticagrelor alongside fibrinolytic therapy in patients with ST-segment elevation myocardial infarction: Practical perspectives based on data from the TREAT study. Clin Cardiol 2018; 41:1322-1327. [PMID: 30098028 DOI: 10.1002/clc.23043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 01/03/2023] Open
Abstract
Primary percutaneous coronary intervention (PCI) is the preferred reperfusion method in patients with ST-segment elevation myocardial infarction (STEMI). In patients with STEMI who cannot undergo timely primary PCI, pharmacoinvasive treatment is recommended, comprising immediate fibrinolytic therapy with subsequent coronary angiography and rescue PCI if needed. Improving clinical outcomes following fibrinolysis remains of great importance for the many patients globally for whom rapid treatment with primary PCI is not possible. For patients with acute coronary syndrome who underwent primary PCI, the PLATO trial demonstrated superior efficacy of ticagrelor relative to clopidogrel. Results in the predefined subgroup of patients with STEMI were consistent with the overall PLATO trial. Patients who received fibrinolytic therapy in the 24 hours before randomization were excluded from PLATO, and there is thus a lack of data on the safety of using ticagrelor in conjunction with fibrinolytic therapy in the first 24 hours after STEMI. The TREAT study addresses this knowledge gap; patients with STEMI who had symptom onset within the previous 24 hours and had received fibrinolytic therapy (of whom 89.4% had also received clopidogrel) were randomized to treatment with ticagrelor or clopidogrel (median time between fibrinolysis and randomization: 11.5 hours). At 30 days, ticagrelor was found to be non-inferior to clopidogrel for the primary safety outcome of Thrombolysis in Myocardial Infarction (TIMI)-defined first major bleeding. Considering together the results of the PLATO and TREAT studies, initiating or switching to treatment with ticagrelor within the first 24 hours after STEMI in patients receiving fibrinolysis is reasonable.
Collapse
Affiliation(s)
| | | | | | | | - Oleg Averkov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Philip Aylward
- South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia
| | | | | | | | | | | | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
22
|
Rebeiz A, Sasso R, Bachir R, Mneimneh Z, Jabbour R, El Sayed M. Emergency Medical Services Utilization and Outcomes of Patients with ST-Elevation Myocardial Infarction in Lebanon. J Emerg Med 2018; 55:827-835. [PMID: 30301584 DOI: 10.1016/j.jemermed.2018.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/30/2018] [Accepted: 09/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Arrival of patients with ST-elevation myocardial infarction (STEMI) by Emergency Medical Services (EMS) results in shorter reperfusion times and lower mortality in developed countries. OBJECTIVES This study examines EMS use by STEMI patients in Lebanon and associated clinical outcomes. METHODS A retrospective observational study with chart review was carried out for STEMI patients arriving to the Emergency Department of a tertiary care center in Lebanon between January 1, 2013 and August 31, 2016. A descriptive analysis was done and followed by a bivariate analysis comparing two groups of patients (EMS vs. Non-EMS). RESULTS A total of 280 patients were included in the study. They were mostly male (71.8%). Mean age was 65.1 years (95% confidence interval [CI] 63.4-66.9). Only 12.5% (95% CI 8.6-16.4) presented by EMS. Chest pain (81.1%) was the most common presenting symptom. Anterior myocardial infarction was the most common electrocardiogram (ECG) diagnosis (51.4%). Most patients were admitted (98.2%), and 72.0% of these patients were treated with primary percutaneous coronary intervention. Cardiogenic shock was the most frequent in-hospital complication (6.2%). The mortality rate was 7.1%. Mean door-to-ECG and door-to-balloon times were 10.8 (95% CI 7.1-14.4) min and 106.2 (95% CI 95.9-116.6) min, respectively. Patients' characteristics, presenting symptoms, outcomes, and performance metrics were similar between the two groups. CONCLUSION EMS is underutilized by STEMI patients in Lebanon and is not associated with improvement in clinical outcomes. Medical oversight and quality initiatives focusing on outcomes of patients with timely sensitive emergencies are needed to advance the prehospital care system in Lebanon.
Collapse
Affiliation(s)
- Abdallah Rebeiz
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roula Sasso
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Bachir
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Mneimneh
- Quality, Accreditation & Risk Management Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Jabbour
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; EMS and Prehospital Care Program, Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
23
|
Nadar SK, Mujtaba M, Al-Hadi H, Sadiq M, Al-Riyami A, Ali M, Al-Lawati H. Epidemiology, Outcomes and Coronary Angiography Findings of Patients Following Out-of-Hospital Cardiac Arrest: A single-centre experience from Oman. Sultan Qaboos Univ Med J 2018; 18:e155-e160. [PMID: 30210844 DOI: 10.18295/squmj.2018.18.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/07/2018] [Accepted: 03/01/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Out-of-hospital cardiac arrests (OHCAs) are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman. Methods This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. All adult patients who presented following an OHCA to the Emergency Department of SQUH during the study period were included. Demographic and clinical data were collected from electronic medical records. Results A total of 216 patients were included in the study. The majority (63.9%) presented after having collapsed, while 22.3% presented with chest pains. Asystole was the most frequent initial cardiac rhythm (62.5%), with only 10% having ventricular tachycardia/fibrillation. Very few patients (1.4%) had received cardiopulmonary resuscitation (CPR) prior to presentation. In total, 85 patients (39.4%) returned to spontaneous circulation (RSC); of these, post-RSC electrocardiography revealed an ST-segment elevation in 41.2% and normal findings in 23.5%. There were 63 patients who underwent coronary angiography, with 28 requiring stenting. Overall, 13% of patients survived and were discharged, although three survivors suffered permanent hypoxic brain damage. Conclusion The overall survival rate of patients who had experienced an OHCA was low. Education programmes should focus on the benefits of immediate CPR for individuals experiencing an OHCA, with more opportunities for CPR training to be made available to the general public in Oman.
Collapse
Affiliation(s)
- Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohammed Mujtaba
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hafidh Al-Hadi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Muhammed Sadiq
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adil Al-Riyami
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mehar Ali
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hatim Al-Lawati
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| |
Collapse
|
24
|
Albackr HB, AlHabib KF, AlShamiri MQ, Ullah A, Al Subaie FA, Alghamdi AG, Alfaleh H, Kashour T, Al Suwaidi J, Alsheikh-Ali AA, Almahmeed W, Salam AM. Circadian Rhythm and ST-Segment Elevation Myocardial Infarction: Insights From the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps). Angiology 2018; 70:352-360. [DOI: 10.1177/0003319718797470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Circadian rhythms have been identified in multiple physiological processes that may affect cardiovascular diseases, yet little is known about the impact of circadian rhythm on acute ST-segment elevation myocardial infarction (STEMI) onset and outcomes in the Middle East. The relationship between time of symptom onset during the 24-hour circadian cycle and prehospital delays and in-hospital death was assessed in 2909 patients with STEMI presenting in 6 Arabian Gulf countries. A sinusoidal smoothing function was used to show the average circadian trends. There was a significant association between time of symptom onset and the circadian cycle. The STEMIs were more frequent during the late morning and early afternoon hours ( P < .001). Patients with pain onset from 0.00 to 5:59 had median prehospital delays of 150 minutes versus 90 minutes from 6:00 to 11:59 and 12:00 to 17:59, respectively ( P < .001). Although there was no significant difference in mortality between the 4 groups ( P = .230), there was a significant association between time of symptom onset as sinusoidal function and in-hospital mortality ( P = .032). Patients with STEMI in the Middle East have significant circadian patterns in symptoms onset, prehospital delay, and timeliness of reperfusion. A circadian rhythm of in-hospital mortality was found over the 24-hour clock of symptom onset time.
Collapse
Affiliation(s)
- Hanan B. Albackr
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Khalid F. AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mostafa Q. AlShamiri
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Fahad A. Al Subaie
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abduljabar G. Alghamdi
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hussam Alfaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Alawi A. Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Amar M. Salam
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
| |
Collapse
|
25
|
Alyahya AA, Alghammass MA, Aldhahri FS, Alsebti AA, Alfulaij AY, Alrashed SH, Faleh HA, Alshameri M, Alhabib K, Arafah M, Moberik A, Almulaik A, Al-Aseri Z, Kashour TS. The impact of introduction of Code-STEMI program on the reduction of door-to-balloon time in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A single-center study in Saudi Arabia. J Saudi Heart Assoc 2018; 30:172-179. [PMID: 29989037 PMCID: PMC6035382 DOI: 10.1016/j.jsha.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 11/10/2022] Open
Abstract
Objectives This study was conducted to evaluate the effect of direct emergency department activation of the catheterization lab on door-to-balloon time (D2BT) and outcomes of acute ST-elevation myocardial infarction (STEMI) patients at a major tertiary care hospital in Riyadh, Saudi Arabia. Methods This was a retrospective cohort study that enrolled 100 consecutive patients with acute STEMI who underwent primary percutaneous coronary intervention between June 2010 and January 2015. The patients were divided into two groups of 50 patients each. The first group was treated prior to establishing the Code-STEMI protocol. The other group was treated according to the protocol, which was implemented in June 2013. The Code-STEMI protocol is a comprehensive program implementing direct activation of the catheterization lab team using a single call system, data monitoring and feedback, and standardized order forms. Results The mean age for both groups was 54 ± 12 years. Males represented 86% (43) and 94% (47) of the patients in the two groups, respectively. In both groups, 90% (90) of patients had one or more comorbidities. The Code-STEMI group had a significantly lower D2BT, with 70% of patients treated within the recommended 90 minutes (median, 76.5 minutes; interquartile range, 63–90 minutes). By contrast, only 26% of pre-Code-STEMI patients were treated within this timeframe (median, 107 minutes; interquartile range, 74–149 minutes). In-hospital complications were lower in the Code-STEMI group; however, the only statistically significant reduction was in non-fatal re-infarction (8% vs. 0%, p = 0.043). Conclusion Implementation of direct emergency department catheterization lab activation protocol was associated with a significant reduction in D2BT.
Collapse
Affiliation(s)
| | | | - Fahad Saleh Aldhahri
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | | | - Abdullah Yousef Alfulaij
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Saleh Hamad Alrashed
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Husam Al Faleh
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mostafa Alshameri
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alhabib
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Arafah
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abduellah Moberik
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Almulaik
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Zuhair Al-Aseri
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Tarek Seifaw Kashour
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Cardiology, King Fahad Cardiac Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
26
|
Factors influencing patient delay before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: The Stent for life initiative in Portugal. Rev Port Cardiol 2018; 37:409-421. [DOI: 10.1016/j.repc.2017.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/11/2017] [Accepted: 07/05/2017] [Indexed: 11/21/2022] Open
|
27
|
Pereira H, Calé R, Pinto FJ, Pereira E, Caldeira D, Mello S, Vitorino S, Almeida MDS, Mimoso J. Factors influencing patient delay before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: The Stent for life initiative in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|
28
|
Turk-Adawi K, Sarrafzadegan N, Fadhil I, Taubert K, Sadeghi M, Wenger NK, Tan NS, Grace SL. Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden. Nat Rev Cardiol 2017; 15:106-119. [PMID: 28933782 DOI: 10.1038/nrcardio.2017.138] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Eastern Mediterranean region (EMR) comprises 22 countries or territories spanning from Morocco in the west to Pakistan in the east, and contains a population of almost 600 million people. Like many other developing regions, the burden of disease in the EMR has shifted in the past 30 years from primarily communicable diseases to noncommunicable diseases such as cardiovascular disease (CVD). Cardiovascular mortality in the EMR, mostly attributable to ischaemic heart disease, is expected to increase more dramatically in the next decade than in any other region except Africa. The most prominent CVD risk factors in this region include tobacco consumption, physical inactivity, depression, obesity, hypertension, and diabetes mellitus. Many individuals living in the EMR are unaware of their risk factor status, and even if treated, these risk factors are often poorly controlled. Furthermore, infrequent use of emergency medical services, delays in access to care, and lack of access to cardiac catheterization affects the timely diagnosis of CVD. Treatment of CVD is also suboptimal in this region, consisting primarily of thrombolysis, with insufficient provision of timely revascularization. In this Review, we summarize what is known about CVD burden, risk factors, and treatment strategies for individuals living in the EMR. This information will hopefully aid decision-makers when devising strategies on how to improve CVD prevention and management in this region.
Collapse
Affiliation(s)
- Karam Turk-Adawi
- Public Health Department, College of Health Sciences, Qatar University, Al Jamea Street, Doha, Qatar
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Ibtihal Fadhil
- Noncommunicable Diseases, World Health Organization, East Mediterranean Regional Office, Monazamet El Seha El Alamia Street, extension of Abdel Razak El Sanhouri Street, Nasr City, Cairo, Egypt
| | - Kathryn Taubert
- International Science and Health Strategies, American Heart Association, Aeschengraben 14, Basel 4051, Switzerland
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center. Cardiovascular Research Institute. Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran
| | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Atlanta, Georgia 30303, USA
| | - Nigel S Tan
- University Health Network, 585 University Ave, Toronto, Ontario M5G 2N2, Canada
| | - Sherry L Grace
- University Health Network, 585 University Ave, Toronto, Ontario M5G 2N2, Canada.,School of Kinesiology and Health Science, York University, Bethune 368, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| |
Collapse
|
29
|
Tiulim J, Mak K, Shavelle DM. ST segment elevation myocardial infarction in patients hospitalized for non-cardiac conditions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:17-20. [PMID: 28600021 DOI: 10.1016/j.carrev.2017.05.021] [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] [Received: 03/27/2017] [Revised: 05/18/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Timely use of primary percutaneous coronary intervention (PCI) is the standard of care for patients with ST segment elevation myocardial infarction (STEMI). Most patients with STEMI present via emergency medical services or self-transport to the emergency department (ED) and relatively little is known about the minority of patients that develop STEMI while hospitalized for non-cardiac conditions. The objective of this study was to analyze treatment times and clinical outcome for in-hospital STEMI patients. METHODS Two-hundred fifty-five patients with STEMI treated at Keck Medical Center of USC and Los Angeles County USC Medical Center from January, 2009 to December, 2013 were retrospectively analyzed. Demographics, treatment time intervals and clinical outcome were collected. Patients arriving via the ED (ED STEMI Group, n=228; 89%) were compared to patients that developed in-hospital STEMI (In-hospital STEMI Group, n=27; 11%). RESULTS Patients with in-hospital STEMI were similar in age, gender and associated medical conditions to ED STEMI patients. In-hospital STEMI patients were less likely to present with chest pain compared to ED STEMI patients, 5% vs. 79%, respectively, p<0.0001. Time from first abnormal electrocardiogram to device was 195±202min for in-hospital STEMI Group compared to door to device time of 88±64min for ED STEMI Group, p<0.001. Length of hospital stay was significantly longer for in-hospital STEMI Group compared to ED STEMI Group, 13±10 vs. 6.8±7.8days, respectively, p<0.001. In-hospital mortality was significantly higher for the in-hospital STEMI Group compared to the ED STEMI Group, 37% vs. 7%, respectively, p<0.001. CONCLUSIONS In-hospital STEMI patients have significant treatment delays and worse clinical outcome compared to STEMI patients that present via the emergency department. Additional efforts are required to promptly identify in-hospital patients that develop STEMI.
Collapse
Affiliation(s)
- Justin Tiulim
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA
| | - Kevin Mak
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA
| | - David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA.
| |
Collapse
|
30
|
AlShammari T, Jennings P, Williams B. Evolution of emergency medical services in Saudi Arabia. JOURNAL OF EMERGENCY MEDICINE, TRAUMA AND ACUTE CARE 2017. [DOI: 10.5339/jemtac.2017.4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: The purpose of this study was to provide an overview of the evolution of emergency medical services (EMS) in Saudi Arabia to describe its history, organisational service providers, governance, EMS statistics and the educational development of the field with the disparity of educational approaches. Background: The EMS is an important part of the healthcare system as it is often the first point of contact for medical emergencies. The EMS in Saudi Arabia has seen a number of positive changes over the past decade, some of which include the development of several university and college programs dedicated to teaching EMS, the evaluation of the profession from a post-employment first aid model into a pre-employment bachelor's degree model, the generous governmental scholarship grants overseas and the official accreditation of EMS as a profession. It has been approximately nine years since the first EMS bachelor's degree programs were developed in Saudi Arabia, some of which were directly adopted from universities in developed countries such as Australia. Despite these positive changes, the current EMS system in Saudi is faced with many challenges, both organisational and educational, including the lack of research, community involvement, the educational status of practitioners and the inconsistencies of statistics relating to response time and rate of transfer. This paper describes the history of EMS in Saudi Arabia with a specific focus on identifying the disparity in the educational outcomes and approaches adopted by colleges and universities in the Kingdom. Methods: The data utilised for the research of the EMS profession in Saudi Arabia were obtained from the literature using search tools such as MEDLINE, Google Scholar, Saudi health journals, Saudi university websites, government reports and statistics. Conclusion: The EMS profession in Saudi Arabia has advanced greatly in the past 12 years. Yet there is still scope for considerable improvement, especially with regards to developing empirically identified core competencies for EMS bachelor's degree graduates. There is also the need for providing more outreach to the public to improve awareness of current services and available training, building more collaboration between the industry employers and academic institutions and investing further in EMS research through the development of Saudi-based postgraduate master's and PhD EMS degrees. This paper is the first to provide an overview of the EMS service in Saudi Arabia, for institutions and researchers to gain a better understanding of the history and current standing of the service from an educational and operational perspective.
Collapse
Affiliation(s)
- Talal AlShammari
- Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| | - Paul Jennings
- Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| | - Brett Williams
- Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| |
Collapse
|