31 research outputs found
Temporal Trends of System of Care for STEMI: Insights from the Jakarta Cardiovascular Care Unit Network System
<div><p>Aim</p><p>Guideline implementation programs are of paramount importance in optimizing acute ST-elevation myocardial infarction (STEMI) care. Assessment of performance indicators from a local STEMI network will provide knowledge of how to improve the system of care.</p><p>Methods and Results</p><p>Between 2008–2011, 1505 STEMI patients were enrolled. We compared the performance indicators before (n = 869) and after implementation (n = 636) of a local STEMI network. In 2011 (after introduction of STEMI networking) compared to 2008–2010, there were more inter-hospital referrals for STEMI patients (61% vs 56%, p<0.001), more primary percutaneous coronary intervention (PCI) procedures (83% vs 73%, p = 0.005), and more patients reaching door-to-needle time ≤30 minutes (84.5% vs 80.2%, p<0.001). However, numbers of patients who presented very late (>12 hours after symptom onset) were similar (53% vs 51%, NS). Moreover, the numbers of patients with door-to-balloon time ≤90 minutes were similar (49.1% vs 51.3%, NS), and in-hospital mortality rates were similar (8.3% vs 6.9%, NS) in 2011 compared to 2008–2010.</p><p>Conclusion</p><p>After a local network implementation for patients with STEMI, there were significantly more inter-hospital referral cases, primary PCI procedures, and patients with a door-to-needle time ≤30 minutes, compared to the period before implementation of this network. However, numbers of patients who presented very late, the targeted door-to-balloon time and in-hospital mortality rate were similar in both periods. To improve STEMI networking based on recent guidelines, existing pre-hospital and in-hospital protocols should be improved and managed more carefully, and should be accommodated whenever possible.</p></div
Demographic data and hospitalization information of STEMI patients (N = 1505).
<p>BMI = body mass index, CAD = coronary artery disease.</p
Patient distribution in the Jakarta Acute Coronary Syndrome registry.
<p>ACS = acute coronary syndrome, STEMI = ST-elevation myocardial infarction, PCI = percutaneous coronary intervention, TIMI = Thrombolysis in Myocardial Infarction.</p
Included countries grouped by World Health Organization region.
<p>DRC, Democratic Republic of the Congo.</p
Reported management of heart failure, by region.
<p>Reported management of heart failure, by region.</p
Meta-regression of diuretic use against study period.
<p>Meta-regression of diuretic use against study period.</p
Aetiology of heart failure: valvular heart disease by region.
<p>Percentage of heart failure cases with a documented cause of valvular heart disease.</p
Reported causes of heart failure, by region.
<p>Reported causes of heart failure, by region.</p
Beta-blocker use by region.
<p>∧Rahimzadeh S, Farzadfar F, Ghaziani M (2013) Iranian hospital data project (unpublished data).</p
Correlation of age and human development index, by country.
<p><i>r</i> = 0.71, <i>p</i><0.001. The HDI is a measure produced by the United Nations Development Programme that incorporates gross national income per capita, life expectancy, and time spent in education. It serves as a single statistic that provides a comparable measure of development across nations. HF, heart failure.</p