Structure, Process, and Mortality Associated with Acute Coronary Syndrome Management in Guatemala’s National Healthcare System: The ACS-GT Registry

Background: Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). The leading cause of mortality in Guatemala is acute myocardial infarction (AMI) and there is no established national policy nor current standard of care. Objective: Describe the factors that influence ACS outcome, evaluating the national healthcare system’s quality of care based on the Donabedian health model. Methods: The ACS-Gt study is an observational, multicentre, and prospective national registry. A total of 109 ACS adult patients admitted at six hospitals from Guatemala’s National Healthcare System were included. These represent six out of the country’s eight geographic regions. Data enrolment took place from February 2020 to January 2021. Data was assessed using chi-square test, Student’s t-test, or Mann-Whitney U test, whichever applied. A p-value < 0.05 was considered statistically significant. Results: One hundred and nine patients met inclusion criteria (80.7% STEMI, 19.3% NSTEMI/UA). The population was predominantly male, (68%) hypertensive (49.5%), and diabetic (45.9%). Fifty-nine percent of STEMI patients received fibrinolysis (alteplase 65.4%) and none for primary Percutaneous Coronary Intervention (pPCI). Reperfusion success rate was 65%, and none were taken to PCI afterwards in the recommended time period (2–24 hours). Prognostic delays in STEMI were significantly prolonged in comparison with European guidelines goals. Optimal in-hospital medical therapy was 8.3%, and in-hospital mortality was 20.4%. Conclusions: There is poor access to ACS pharmacological treatment, low reperfusion rate, and no primary, urgent, or rescue PCI available. No patient fulfilled the recommended time period between successful fibrinolysis and PCI. Resources are limited and inefficiently used

Evaluación de competencias en urgencias médicas por simulación : Estudio de los conocimientos, habilidades y actitudes adquiridos por los estudiantes del Ejercicio Profesional Supervisado Hospitalario de la Facultad de Ciencias Médicas de la Universidad de San Carlos de Guatemala. Hospital General San Juan de Dios, Guatemala 2014.

El objetivo de este trabajo fue describir las competencias en los estudiantes del último año de la carrera de Ciencias Médicas, adquiridas en años anteriores y los reforzados en las rotaciones del EPSH sobre el manejo de urgencias médicas; previos y posteriores a la actividad por simulación. Es un estudio descriptivo, en donde participaron 24 estudiantes del último año de la carrera de Ciencias Médicas de la Universidad de San Carlos de Guatemala, que se encontraban realizando el Ejercicio Profesional Supervisado Hospitalario (EPSH) en el Hospital General San Juan de Dios (HGSJDD) en el período de febrero-julio 2014; se realizaron seis cursos de simulación de 10 integrantes cada uno, con una evaluación escrita semiestructurada de 36 preguntas antes y después del curso; la información fue transcrita según los componentes elaborando un análisis e interpretación por objetivos