[Percutaneous interventions in cardiology in Poland in 2014. Summary report of the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK)]

Nurse-managed education: the effectiveness of secondary prevention after acute coronary syndromes and the prevalence and predictors of dropout from a cardiac rehabilitation programme

INTRODUCTION

Education programmes are now very often used to limit the consequences associated with a steady increase in the incidence of cardiovascular disease. It is important to assess the effectiveness of these programmes and the reasons why people drop out.

AIM

To evaluate the effects of intensive education of patients undergoing acute invasive cardiology procedures compared to the control group (patients educated in a classical way).

MATERIAL AND METHODS

Randomized trial. Measurements of body weight and body composition: during hospital stay, at 45 and 180 days after acute coronary syndrome. We used a self-prepared questionnaire, LOR-T and a TANITA BC1000 body composition analyser.

RESULTS

The sample consisted of 73 patients aged 48 to 89 years. Men constituted 58.9% of the participants. 43.8% of the respondents appeared for a follow-up visit after 45 days, and after 180 days 32.8% came. Body weight, body mass index (BMI), and health condition of the patients did not change significantly during the study. 67.1% of respondents dropped out from the nurse-managed cardiac education programme. People who were in better health, smoking, without comorbidities, having a heart attack, living far from the place of education more often dropped out from follow-up visits.

CONCLUSIONS

Patient education proved ineffective. Body weight, BMI, and health condition of the subjects, both at the time of inclusion and during the long-term evaluation, were very unfavourable.

The effects of prehospital system delays on the treatment efficacy of STEMI patients

BACKGROUND

Cardiovascular disease accounts for nearly half of all deaths in Poland. The aim of this study was to assess both the duration and the delays of prehospital treatment in ST-segment elevation myocardial infarction (STEMI) patients and how it impacts left ventricle ejection fraction (LVEF) measured at the time of discharge and the frequency of in-hospital patient mortality.

METHODS

This study retrospectively analyzed medical records from January 2011 to December 2015 (excluding the year 2013) of 573 patients who were transported to a hospital with a diagnosis of STEMI.

RESULTS

The mean time of prehospital system delays was 59 min with a maximum time of 152 min and a minimum time of 23 min. The relationship between reduced LVEF (< 55%) and in-hospital patient mortality and the relationship between length of time from first medical contact (FMC) to hospital admission was analysed in 515 respondents. Extending the time of FMC to hospital admission by 1 min increased the chances of lowering LVEF by 2% (95% CI: 1.004-1.041) and increased the chances of death by 2% (95% CI: 1.002-1.04) in STEMI patients.

CONCLUSIONS

This study emphasised how vital it is to minimise time spent with STEMI patients at the scene of their cardiovascular event by performing an ECG as quickly as possible and by immediately transporting the patient to the hospital with the targeted treatment. This may lead to the implementation of additional training in the field of ECG interpretation, increase the prevalence of teletransmission systems, and improve communication between Emergency Medical Services (EMS) and catheterization laboratories ultimately reducing patient mortality.