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Doan T, Howell S, Ball S, Finn J, Cameron P, Bosley E, Dicker B, Faddy S, Nehme Z, Heriot N, Swain A, Thorrowgood M, Thomas A, Perillo S, McDermott M, Smith T, Smith K, Belcher J, Bray J. Correction: Identifying areas of Australia with high out-of-hospital cardiac arrest incidence and low bystander cardiopulmonary resuscitation rates: A retrospective, observational study. PLoS One 2024; 19:e0303681. [PMID: 38722859 PMCID: PMC11081294 DOI: 10.1371/journal.pone.0303681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0301176.].
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Doan T, Howell S, Ball S, Finn J, Cameron P, Bosley E, Dicker B, Faddy S, Nehme Z, Heriot N, Swain A, Thorrowgood M, Thomas A, Perillo S, McDermott M, Smith T, Smith K, Belcher J, Bray J. Identifying areas of Australia with high out-of-hospital cardiac arrest incidence and low bystander cardiopulmonary resuscitation rates: A retrospective, observational study. PLoS One 2024; 19:e0301176. [PMID: 38652707 PMCID: PMC11037527 DOI: 10.1371/journal.pone.0301176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/12/2024] [Indexed: 04/25/2024] Open
Abstract
AIM This study aims to explore regional variation and identify regions within Australia with high incidence of out-of-hospital cardiac arrest (OHCA) and low rates of bystander cardiopulmonary resuscitation (CPR). METHOD Adult OHCAs of presumed medical aetiology occurring across Australia between 2017 and 2019 were mapped onto local government areas (LGA) using the location of arrest coordinates. Bayesian spatial models were applied to provide "smoothed" estimates of OHCA incidence and bystander CPR rates (for bystander-witnessed OHCAs) for each LGA. For each state and territory, high-risk LGAs were defined as those with an incidence rate greater than the state or territory's 75th percentile and a bystander CPR rate less than the state or territory's 25th percentile. RESULTS A total of 62,579 OHCA cases attended by emergency medical services across 543 LGAs nationwide were included in the study. Nationally, the OHCA incidence rate across LGA ranged from 58.5 to 198.3 persons per 100,000, while bystander CPR rates ranged from 45% to 75%. We identified 60 high-risk LGAs, which were predominantly located in the state of New South Wales. Within each region, high-risk LGAs were typically located in regional and remote areas of the country, except for four metropolitan areas-two in Adelaide and two in Perth. CONCLUSIONS We have identified high-risk LGAs, characterised by high incidence and low bystander CPR rates, which are predominantly in regional and remote areas of Australia. Strategies for reducing OHCA and improving bystander response may be best targeted at these regions.
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Affiliation(s)
- Tan Doan
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Stuart Howell
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, Western Australia, Australia
- St John Western Australia, Belmont, Western Australia, Australia
| | - Judith Finn
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, Western Australia, Australia
- St John Western Australia, Belmont, Western Australia, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane City, Queensland, Australia
| | - Bridget Dicker
- Hato Hone St John New Zealand, Auckland, New Zealand
- Auckland University of Technology, Auckland, New Zealand
| | - Steven Faddy
- NSW Ambulance, Sydney, New South Wales, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
| | | | - Andy Swain
- Wellington Free Ambulance, Wellington, New Zealand
| | | | - Andrew Thomas
- St John Ambulance NT, Darwin, Northern Territory, Australia
| | - Samuel Perillo
- ACT Ambulance, Canberra, Australian Capital Territory, Australia
| | | | - Tony Smith
- Hato Hone St John New Zealand, Auckland, New Zealand
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Research and Innovation, Silverchain, Victoria, Australia
| | - Jason Belcher
- St John Western Australia, Belmont, Western Australia, Australia
| | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, Western Australia, Australia
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Howell S, Smith K, Finn J, Cameron P, Ball S, Bosley E, Doan T, Dicker B, Faddy S, Nehme Z, Swain A, Thorrowgood M, Thomas A, Perillo S, McDermott M, Smith T, Bray J. The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand. Resuscitation 2023:109847. [PMID: 37211232 DOI: 10.1016/j.resuscitation.2023.109847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The aim of this study was to develop a risk adjustment strategy, including effect modifiers, for benchmarking emergency medical service (EMS) performance for out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand. METHOD Using 2017-2019 data from the Australasian Resuscitation Outcomes Consortium (Aus-ROC) OHCA Epistry, we included adults who received an EMS attempted resuscitation for a presumed medical OHCA. Logistic regression was applied to develop risk adjustment models for event survival (return of spontaneous circulation at hospital handover) and survival to hospital discharge/30 days. We examined potential effect modifiers, and assessed model discrimination and validity. RESULTS Both OHCA survival outcome models included EMS agency and the Utstein variables (age, sex, location of arrest, witnessed arrest, initial rhythm, bystander cardiopulmonary resuscitation, defibrillation prior to EMS arrival, and EMS response time). The model for event survival had good discrimination according to the concordance statistic (0.77) and explained 28% of the variation in survival. The corresponding figures for survival to hospital discharge/30 days were 0.87 and 49%. The addition of effect modifiers did little to improve the performance of either model. CONCLUSION The development of risk adjustment models with good discrimination is an important step in benchmarking EMS performance for OHCA. The Utstein variables are important in risk-adjustment, but only explain a small proportion of the variation in survival. Further research is required to understand what factors contribute to the variation in survival between EMS.
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Affiliation(s)
- Stuart Howell
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Department of Paramedicine, Monash University, Victoria, Australia
| | - Judith Finn
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Western Australia, Australia; St John Western Australia, Western Australia, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Western Australia, Australia; St John Western Australia, Western Australia, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Queensland, Australia
| | - Tan Doan
- Queensland Ambulance Service, Queensland, Australia
| | - Bridget Dicker
- St John New Zealand, Auckland, New Zealand; Auckland University of Technology, Auckland, New Zealand
| | | | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia
| | | | | | | | | | | | - Tony Smith
- St John New Zealand, Auckland, New Zealand
| | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Western Australia, Australia.
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Bray J, Howell S, Ball S, Doan T, Bosley E, Smith K, Dicker B, Faddy S, Thorrowgood M, Swain A, Thomas A, Wilson A, Shipp C, Walker T, Bailey P, Finn J. The epidemiology of out-of-hospital cardiac arrest in Australia and New Zealand: A binational report from the Australasian Resuscitation Outcomes Consortium (Aus-ROC). Resuscitation 2022; 172:74-83. [PMID: 35077857 DOI: 10.1016/j.resuscitation.2022.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/04/2022] [Accepted: 01/15/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Australasian Resuscitation Outcomes Consortium (Aus-ROC) out-of-hospital cardiac arrest (OHCA) Epistry (Epidemiological Registry) now covers 100% of Australia and New Zealand (NZ). This study reports and compares the Utstein demographics, arrest characteristics and outcomes of OHCA patients across our region. METHODS We included all OHCA cases throughout 2019 as submitted to the Epistry by the eight Australian and two NZ emergency medical services (EMS). We calculated crude and age-standardised incidence rates and performed a national and EMS regional comparison. RESULTS We obtained data for 31,778 OHCA cases for 2019: 26,637 in Australia and 5,141 in NZ. Crude incidence was 107.9 per 100,000 person-years in Australia and 103.2/100,000 in NZ. Overall, the majority of OHCAs occurred in adults (96%), males (66%), private residences (76%), were unwitnessed (63%), of presumed medical aetiology (83%), and had an initial monitored rhythm of asystole (64%). In non-EMS-witnessed cases, 38% received bystander CPR and 2% received public defibrillation. Wide variation was seen between EMS regions for all OHCA demographics, arrest characteristics and outcomes. In patients who received an EMS-attempted resuscitation (13,664/31,778): 28% (range across EMS=13.1% to 36.7%) had return of spontaneous circulation (ROSC) at hospital arrival and 13% (range across EMS=9.9% to 20.7%) survived to hospital discharge/30-days. Survival in the Utstein comparator group (bystander-witnessed in shockable rhythm) varied across the EMS regions between 27.4% to 42.0%. CONCLUSION OHCA across Australia and NZ has varied incidence, characteristics and survival. Understanding the variation in survival and modifiable predictors is key to informing strategies to improve outcomes.
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Affiliation(s)
- Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Western Australia, Australia.
| | - Stuart Howell
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Western Australia, Australia; St John Western Australia, Western Australia, Australia
| | - Tan Doan
- Queensland Ambulance Service, Queensland, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Queensland, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| | - Bridget Dicker
- St John New Zealand, Auckland, New Zealand; Auckland University of Technology, Auckland, New Zealand
| | | | | | - Andy Swain
- Wellington Free Ambulance, Wellington, New Zealand
| | | | | | | | | | - Paul Bailey
- St John Western Australia, Western Australia, Australia
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Western Australia, Australia; St John Western Australia, Western Australia, Australia
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Faddy S, McMullen M. Differential Effects of Delayed Presentation to Emergency Medical Services in Male and Female Patients Suffering STEMI. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Faddy S, Stewart P, Savage L, Fletcher P. Prehospital Thrombolysis Program Reduces the Time to Reperfusion Therapy in Patients Suffering STEMI in Rural and Regional NSW. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Madronio C, Faddy S, Fathieh S, Knibbs L, Negishi K. No Increase in Out-of-Hospital Cardiac Arrests During the COVID-19 Pandemic, Despite Reduction in Acute Coronary Syndrome in NSW, Australia. Heart Lung Circ 2021. [PMCID: PMC8324100 DOI: 10.1016/j.hlc.2021.06.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Arnold RH, Tideman PA, Devlin GP, Carroll GE, Elder A, Lowe H, Macdonald PS, Bannon PG, Juergens C, McGuire M, Mariani JA, Coffey S, Faddy S, Brown A, Inglis S, Wang WYS. Rural and Remote Cardiology During the COVID-19 Pandemic: Cardiac Society of Australia and New Zealand (CSANZ) Consensus Statement. Heart Lung Circ 2020; 29:e88-e93. [PMID: 32487432 PMCID: PMC7203036 DOI: 10.1016/j.hlc.2020.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
THE CHALLENGES Rural and remote Australians and New Zealanders have a higher rate of adverse outcomes due to acute myocardial infarction, driven by many factors. The prevalence of cardiovascular disease (CVD) is also higher in regional and remote populations, and people with known CVD have increased morbidity and mortality from coronavirus disease 2019 (COVID-19). In addition, COVID-19 is associated with serious cardiac manifestations, potentially placing additional demand on limited regional services at a time of diminished visiting metropolitan support with restricted travel. Inter-hospital transfer is currently challenging as receiving centres enact pandemic protocols, creating potential delays, and cardiovascular resources are diverted to increasing intensive care unit (ICU) and emergency department (ED) capacity. Regional and rural centres have limited staff resources, placing cardiac services at risk in the event of staff infection or quarantine during the pandemic. MAIN RECOMMENDATIONS Health districts, cardiologists and government agencies need to minimise impacts on the already vulnerable cardiovascular health of regional and remote Australians and New Zealanders throughout the COVID-19 pandemic. Changes in management should include.
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Affiliation(s)
| | - Philip A Tideman
- Integrated Cardiovascular Clinical Network SA, Adelaide, SA, Australia
| | | | - Gerard E Carroll
- Calvary Hospital, Wagga Wagga, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Alex Elder
- Orange Health Service, Orange, NSW, Australia
| | - Harry Lowe
- Orange Health Service, Orange, NSW, Australia; Concord Hospital, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Peter S Macdonald
- University of New South Wales, Sydney, NSW, Australia; St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - Paul G Bannon
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Craig Juergens
- Orange Health Service, Orange, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; Liverpool Hospital, Sydney, NSW, Australia
| | - Mark McGuire
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia
| | - Justin A Mariani
- Alfred Hospital, Melbourne, Bairnsdale Hospital, Bairnsdale and Monash University, Melbourne, Vic, Australia
| | - Sean Coffey
- University of Otago, Dunedin, and Southern District Health Board, Dunedin, New Zealand
| | | | - Alex Brown
- South Australian Health and Medical Research Institute (SAHMRI) and University of Adelaide, Adelaide, SA, Australia
| | - Sally Inglis
- CSANZ Cardiovascular Nursing Council, University of Technology, Sydney, NSW, Australia
| | - William Y S Wang
- CSANZ Indigenous Health Council, Princess Alexandra Hospital, Brisbane, and University of Queensland, Brisbane, QLD, Australia
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Faddy S, Cohen S, Peresson C. Accuracy in the identification of cardiac arrest by emergency medical dispatchers in New South Wales (NSW), Australia. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khan AA, Williams T, Al-Omary MS, Feeney AL, Majeed T, Savage L, Stewart P, Faddy S, Collins NJ, Fletcher P, Boyle AJ. Pre-hospital thrombolysis for ST-segment elevation myocardial infarction in regional Australia: long-term follow up. Intern Med J 2019; 50:711-715. [PMID: 31237408 DOI: 10.1111/imj.14412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/10/2019] [Accepted: 06/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delivering reperfusion therapy to patients with ST-segment elevation myocardial infarction (STEMI) in regional areas without access to tertiary cardiology care remains challenging. The systems of care in Hunter New England Health, New South Wales, Australia (area covered = 130 000 km2 ) to provide reperfusion to patients with STEMI involve a 12-lead electrocardiogram in the ambulance, discussion between cardiologist and paramedic, followed by pre-hospital thrombolysis (PHT) delivered in ambulance to appropriate patients >60 min from the cardiac catheterisation laboratories. Patients who can access the cardiac catheterisation laboratories within 60 min are treated with primary percutaneous coronary intervention (PCI). AIMS We have previously reported excellent 12-month outcomes for patients receiving PHT and the aim of the current analysis is to look at the long term outcomes. METHODS We assessed long-term all-cause mortality and major adverse cardiovascular events of STEMI patients undergoing PHT in our health district from August 2008 to August 2013 and compared with the primary PCI group. RESULTS One hundred and fifty (mean age: 62 ± 13 years, males: 76%, n = 114) patients were administered PHT and 334 patients (mean age: 65 ± 13 years, males: 75%, n = 251) underwent primary PCI during the study period. During a median follow up of 6.2 years (interquartile range: 4.8-7.4 years) all-cause mortality was 16% and 19% in the PHT and primary PCI groups respectively (P = 0.4). CONCLUSION Our real-world experience shows that PHT followed by early transfer to a primary PCI-capable centre is an effective reperfusion strategy, with comparable results to primary PCI, and mortality benefits are sustained to more than 6 years.
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Affiliation(s)
- Arshad A Khan
- Department of Cardiovascular Medicine, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Trent Williams
- Department of Cardiovascular Medicine, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mohamed S Al-Omary
- Department of Cardiovascular Medicine, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Alex L Feeney
- Department of Cardiovascular Medicine, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Tazeen Majeed
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Lindsay Savage
- Department of Cardiovascular Medicine, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Paul Stewart
- NSW Ambulance, Sydney, New South Wales, Australia
| | - Steven Faddy
- NSW Ambulance, Sydney, New South Wales, Australia
| | - Nicholas J Collins
- Department of Cardiovascular Medicine, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Peter Fletcher
- Department of Cardiovascular Medicine, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Andrew J Boyle
- Department of Cardiovascular Medicine, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Williams T, Savage L, Whitehead N, Orvad H, Cummins C, Faddy S, Fletcher P, Boyle AJ, Inder KJ. Missed Acute Myocardial Infarction (MAMI) in a rural and regional setting. Int J Cardiol Heart Vasc 2019; 22:177-180. [PMID: 30906847 PMCID: PMC6411579 DOI: 10.1016/j.ijcha.2019.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/02/2019] [Accepted: 02/25/2019] [Indexed: 11/22/2022]
Abstract
Background Delay in treatment and/or failure to provide reperfusion in ST-segment elevation myocardial infarction (STEMI) impacts on morbidity and mortality. This occurs more often outside metropolitan areas yet the reasons for this are unclear. This study aimed to describe factors associated with missed diagnosis of acute myocardial infarction (MAMI) in a rural and regional setting. Methods Using a retrospective cohort design, patients who presented with STEMI and failed to receive reperfusion therapy within four hours were identified as MAMI. Univariate analyses were undertaken to identify differences in clinical characteristics between the treated STEMI group and the MAMI group. Mortality, 30-day readmission rates and length of hospital stay are reported. Results Of 100 patients identified as MAMI (70 male, 30 female), 24 died in hospital. Demographics and time from symptom onset were similar in the treated STEMI and MAMI groups. Of the MAMI patients who died, rural hospitals recorded the highest inpatient mortality (69.6% p = 0.008). MAMI patients compared to treated STEMI patients had higher 30 day readmission (31.6% vs 3.3%, p = 0.001) and longer length of stay (5.5 vs 4.3 days p = 0.029). Inaccurate identification of STEMI on electrocardiogram (72%) and diagnostic uncertainty (65%) were associated with MAMI. The Glasgow algorithm to identify STEMI was utilised on 57% of occasions, with 93% accuracy. Conclusion Mortality following MAMI is high particularly in smaller rural hospitals. MAMI results in increased length of stay and readmission rate. Electrocardiogram interpretation and diagnostic accuracy require improvement to determine if this improves patient outcomes.
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Affiliation(s)
- Trent Williams
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia.,School of Nursing and Midwifery, University of Newcastle, Australia
| | - Lindsay Savage
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - Nicholas Whitehead
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - Helen Orvad
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - Claire Cummins
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia
| | | | - Peter Fletcher
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Andrew J Boyle
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Kerry Jill Inder
- School of Nursing and Midwifery, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
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Khan AA, Williams T, Savage L, Stewart P, Ashraf A, Davies AJ, Faddy S, Attia J, Oldmeadow C, Bhagwandeen R, Fletcher PJ, Boyle AJ. Pre-hospital thrombolysis in ST-segment elevation myocardial infarction: a regional Australian experience. Med J Aust 2017; 205:121-5. [PMID: 27465767 DOI: 10.5694/mja15.01336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 06/10/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The system of care in the Hunter New England Local Health District for patients with ST-segment elevation myocardial infarction (STEMI) foresees pre-hospital thrombolysis (PHT) administered by paramedics to patients more than 60 minutes from the cardiac catheterisation laboratory (CCL), and primary percutaneous coronary intervention (PCI) at the CCL for others. We assessed the safety and effectiveness of the pre-hospital diagnosis strategy, which allocates patients to PHT or primary PCI according to travel time to the CCL. DESIGN, SETTING AND PARTICIPANTS Prospective, non-randomised, consecutive, single-centre case series of STEMI patients diagnosed on the basis of a pre-hospital electrocardiogram (ECG), from August 2008 to August 2013. All patients were treated at the tertiary referral hospital (John Hunter Hospital, Newcastle). MAIN OUTCOME MEASURES The primary efficacy endpoint was all-cause mortality at 12 months; the primary safety endpoint was bleeding. RESULTS STEMI was diagnosed in 484 patients on the basis of pre-hospital ECG; 150 were administered PHT and 334 underwent primary PCI. The median time from first medical contact (FMC) to PHT was 35 minutes (IQR, 28-43 min) and to balloon inflation 130 minutes (IQR, 100-150 min). In the PHT group, 37 patients (27%) needed rescue PCI (median time, 4 h; IQR, 3-5 h). The 12-month all-cause mortality rate was 7.0% (PHT, 6.7%; PCI, 7.2%). The incidence of major bleeding (TIMI criteria) in the PHT group was 1.3%; no patients in the primary PCI group experienced major bleeding. CONCLUSION PHT can be delivered safely by paramedical staff in regional and rural Australia with good clinical outcomes.
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Affiliation(s)
| | | | | | | | - Asma Ashraf
- Hunter Medical Research Institute, University of Newcastle, Newcastle
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Elder A, Dunkerton S, Arnold R, Amos D, French A, Ryan E, Faddy S, McMullen M. Delays in Treatment of Rural STEMI: Stoic Patients or System Delays? Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Elder A, Dunkerton S, Arnold R, French A, Amos D, Ryan E, Faddy S, McMullen M. Early Cardiologist Input via LIFENET ECG Transmission and Pre-Hospital Thrombolysis Achieves Improved Lysis Times for STEMI in a Rural Setting. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Faddy S, McMullen M. Mechanical CPR in out-of-hospital cardiac arrest: A non-inferiority meta-analysis. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Faddy S, McMullen M, Stewart P. Epidemiological analysis of a cohort of rural and remote STEMI patients in NSW. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Williams T, Fletcher P, Stewart P, Faddy S, Savage L. PM211 Pre Hospital Thrombolysis - An Examination of Clinical Outcomes. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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19
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Fletcher P, Faddy S, Gallagher S, Savage L, Stewart P. NSW Pre-hospital Thrombolysis. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Watson A, Gao L, Sun L, Faddy S, Doyle A, Hicks M, Dhital K, Jansz P, Macdonald P. Enhanced Cardiac Allograft Preservation by Supplementation of Celsior With Erythropoietin, Glyceryl Trinitrate and Zoniporide—Validation in Small and Large Animal Models. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2010.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Tay AE, Faddy S, Lim S, Walker BD, Kuchar D, Thorburn CW, Macdonald P, Keogh A, Kotlyar E, Farnsworth A, Hayward C, Jansz P, Granger E, Spratt P, Subbiah RN. Permanent Pacing for Late-Onset Atrioventricular Block in Patients with Heart Transplantation: A Single Center Experience. Pacing and Clinical Electrophysiology 2010; 34:72-5. [PMID: 20946303 DOI: 10.1111/j.1540-8159.2010.02906.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andre E Tay
- Department of Cardiology and Cardiac Electrophysiology, St Vincent's Hospital, Sydney, Australia
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Watson A, Gao L, Sun L, Faddy S, Hicks M, Jansz P, Macdonald P. 313: Exogenous T3 Causes Acute Pulmonary Hypertension in a Porcine Model of Brain Death. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Faddy S. Thrombolysis or Transport to a PCI Centre for ST-Elevation Myocardial Infarction in Metropolitan Areas. Heart Lung Circ 2008. [DOI: 10.1016/j.hlc.2008.05.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Faddy S, Jennings P, Cunningham R, Sen A. Biphasic versus monophasic waveforms for transthoracic defibrillation in out-of-hospital cardiac arrest. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd006762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Hing A, Hicks M, Gao L, Faddy S, Tran P, Kesteven S, Sharland A, Stewart G, Macdonald P. THE EFFECTS OF DONOR PRE-TREATMENT ON THE HEART AND OTHER SOLID ORGANS FOR TRANSPLANTATION: A COMPARISON BETWEEN HORMONE RESUSCITATION, NORADRENALINE AND INTRAVENOUS FLUIDS TO IMPROVE ORGAN QUALITY. Heart Lung Circ 2007. [DOI: 10.1016/j.hlc.2007.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Keogh A, Muller D, Faddy S, Ruygrok P, Richardson M, Galbraith A. HEART TRANSPLANT PATIENTS TREATED WITH SIROLIMUS IMMMUNOTHERAPY SHOW SIGNIFICANT REDUCTION IN THE PROGRESSION OF GRAFT VASCULOPATHY AT 2 YEARS. Transplantation 2004. [DOI: 10.1097/00007890-200407271-00421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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