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Shorter door-to-balloon time, better long-term clinical outcomes in ST-segment elevation myocardial infarction patients: J-MINUET substudy. J Cardiol 2023; 81:564-570. [PMID: 36736534 DOI: 10.1016/j.jjcc.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The impact of shorter door-to-balloon (DTB time on long-term outcomes in ST-segment elevation myocardial infarction (STEMI treated with primary percutaneous coronary intervention (PPCI has not been fully elucidated. METHODS We investigated 3283 consecutive patients with acute myocardial infarction selected from a prospective, nationwide, multicenter registry (J-MINUET database comprising 28 institutions in Japan between July 2012 and March 2014. Among the study population, we analyzed 1639 STEMI patients who had PPCI within 12 h of onset. Patients were stratified into four groups (DTB time < 45 min, 45-60 min, 61-90 min, >90 min. The primary endpoint was a composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure, and urgent revascularization for unstable angina up to 3 years. We performed landmark analysis for incidence of the primary endpoint from 31 days to 3 years among the four groups. RESULTS The primary endpoint rate from 31 days to 3 years increased significantly and time-dependently with DTB time (10.2 % vs. 15.3 % vs. 16.2 % vs. 19.3 %, respectively; log-rank p = 0.0129. Higher logarithm-transformed DTB time was associated with greater risk of a primary endpoint from 31 days to 3 years, and the increased number of adverse long-term clinical outcomes persisted even after adjusting for other independent variables. CONCLUSION Shorter DTB time was associated with better long-term clinical outcomes in STEMI patients treated with PPCI in contemporary clinical practice. Further efforts to shorten DTB time are recommended to improve long-term clinical outcomes in STEMI patients. TRIAL REGISTRATION UMIN Unique trial Number: UMIN000010037.
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Gödde D, Bruckschen F, Burisch C, Weichert V, Nation KJ, Thal SC, Marsch S, Sellmann T. Manual and Mechanical Induced Peri-Resuscitation Injuries-Post-Mortem and Clinical Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10434. [PMID: 36012068 PMCID: PMC9408363 DOI: 10.3390/ijerph191610434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
(1) Background: Injuries related to resuscitation are not usually systematically recorded and documented. By evaluating this data, conclusions could be drawn about the quality of the resuscitation, with the aim of improving patient care and safety. (2) Methods: We are planning to conduct a multicentric, retrospective 3-phased study consisting of (1) a worldwide literature review (scoping review), (2) an analysis of anatomical pathological findings from local institutions in North Rhine-Westphalia, Germany to assess the transferability of the review data to the German healthcare system, and (3) depending on the results, possibly establishing potential prospective indicators for resuscitation-related injuries as part of quality assurance measures. (3) Conclusions: From the comparison of literature and local data, the picture of resuscitation-related injuries will be focused on and quality indicators will be derived.
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Affiliation(s)
- Daniel Gödde
- Department of Pathology and Molecularpathology, Helios University Hospital Wuppertal, University Witten/Herdecke, 58455 Witten, Germany
| | - Florian Bruckschen
- Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus BETHESDA zu Duisburg, 47053 Duisburg, Germany
| | - Christian Burisch
- State of North Rhine-Westphalia/Regional Government, 44145 Düsseldorf, Germany
| | - Veronika Weichert
- Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Duisburg, 47249 Duisburg, Germany
| | - Kevin J. Nation
- NZRN, New Zealand Resuscitation Council, Wellington 6011, New Zealand
| | - Serge C. Thal
- Department of Anaesthesiology I, University Witten/Herdecke, 58455 Witten, Germany
- Department of Anesthesiology, HELIOS University Hospital, 42283 Wuppertal, Germany
| | - Stephan Marsch
- Department of Intensive Care, University Hospital, Petersgraben 4, 4031 Basel, Switzerland
| | - Timur Sellmann
- Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus BETHESDA zu Duisburg, 47053 Duisburg, Germany
- Department of Anaesthesiology I, University Witten/Herdecke, 58455 Witten, Germany
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3
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Chang KY, Chiu N, Aggarwal R. In-Hospital Mortality for Inpatient Percutaneous Coronary Interventions in the United States. Am J Cardiol 2021; 159:30-35. [PMID: 34503823 DOI: 10.1016/j.amjcard.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022]
Abstract
Cardiovascular mortality is substantially higher in rural communities compared with urban communities. Understanding if disparities in inpatient percutaneous coronary intervention (PCI) persist in the United States will help inform initiatives to improve cardiovascular health. Of the more than 7 million hospitalizations in the National Inpatient Sample (2016), we identified 80,793 unweighted hospitalizations for PCI using ICD-10 procedure codes. Using survey weights, these hospitalizations projected 371,040 US admissions for inpatient PCI. For the primary analysis, we determined the association between hospital urban-rural designation and in-hospital mortality after inpatient PCI. In the secondary analysis, we evaluated the association between teaching status and this outcome. Multivariable logistic regression models, adjusted for multiple risk factors and patient characteristics, were used. Of the 371,430 hospitalizations for inpatient PCI, there were 108.9 (±2.2) admissions per 100,000 US population from urban hospitals and 152.9 (±6.3) from rural hospitals. Of the urban hospitals, there were 77.7 (±1.9) admissions per 100,000 US population at teaching hospitals (71.7%) and 30.7 (±1.0) at urban nonteaching hospitals (28.3%). In-hospital mortality did not differ between urban and rural hospitals (1.8% urban vs 1.9% rural, adjusted odds ratio for rural compared with urban: 1.15 [95% confidence interval 0.98, 1.34], p = 0.08). In urban hospitals, however, in-hospital mortality was higher in nonteaching hospitals than in teaching hospitals (2.0% nonteaching vs 1.7% teaching, adjusted odds ratio for teaching compared with nonteaching: 1.17 [95% confidence interval 1.01, 1.36], p = 0.04). In conclusion, in-hospital mortality rates after inpatient PCI were similar between urban and rural hospitals in the United States. However, among urban hospitals, nonteaching hospitals had higher rates of in-hospital mortality after PCI. In conclusion, solutions to address disparities for inpatient PCI outcomes between teaching and nonteaching hospitals are needed.
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Affiliation(s)
- Katie Y Chang
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nicholas Chiu
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rahul Aggarwal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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4
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McLaren JTT, Taher AK, Kapoor M, Yi SL, Chartier LB. Sharing and Teaching Electrocardiograms to Minimize Infarction (STEMI): reducing diagnostic time for acute coronary occlusion in the emergency department. Am J Emerg Med 2021; 48:18-32. [PMID: 33838470 DOI: 10.1016/j.ajem.2021.03.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/19/2021] [Accepted: 03/21/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Limits to ST-Elevation Myocardial Infarction (STEMI) criteria may lead to prolonged diagnostic time for acute coronary occlusion. We aimed to reduce ECG-to-Activation (ETA) time through audit and feedback on STEMI-equivalents and subtle occlusions, without increasing Code STEMIs without culprit lesions. METHODS This multi-centre, quality improvement initiative reviewed all Code STEMI patients from the emergency department (ED) over a one-year baseline and one-year intervention period. We measured ETA time, from the first ED ECG to the time a Code STEMI was activated. Our intervention strategy involved a grand rounds presentation and an internal website presenting weekly local challenging cases, along with literature on STEMI-equivalents and subtle occlusions. Our outcome measure was ETA time for culprit lesions, our process measure was website views/visits, and our balancing measure was the percentage of Code STEMIs without culprit lesions. RESULTS There were 51 culprit lesions in the baseline period, and 64 in the intervention period. Median ETA declined from 28.0 min (95% confidence interval [CI] 15.0-45.0) to 8.0 min (95%CI 6.0-15.0). The website garnered 70.4 views/week and 27.7 visitors/week in a group of 80 physicians. There was no change in percentage of Code STEMIs without culprit lesions: 28.2% (95%CI 17.8-38.6) to 20.0% (95%CI 11.2-28.8%). Conclusions Our novel weekly web-based feedback to all emergency physicians was associated with a reduction in ETA time by 20 min, without increasing Code STEMIs without culprit lesions. Local ECG audit and feedback, guided by ETA as a quality metric for acute coronary occlusion, could be replicated in other settings to improve care.
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Affiliation(s)
- Jesse T T McLaren
- Emergency Department, University Health Network, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Ahmed K Taher
- Emergency Department, University Health Network, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Monika Kapoor
- Emergency Department, University Health Network, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Soojin L Yi
- Emergency Department, University Health Network, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Lucas B Chartier
- Emergency Department, University Health Network, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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5
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Park J, Choi KH, Lee JM, Kim HK, Hwang D, Rhee TM, Kim J, Park TK, Yang JH, Song YB, Choi JH, Hahn JY, Choi SH, Koo BK, Chae SC, Cho MC, Kim CJ, Kim JH, Jeong MH, Gwon HC, Kim HS. Prognostic Implications of Door-to-Balloon Time and Onset-to-Door Time on Mortality in Patients With ST -Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2020; 8:e012188. [PMID: 31041869 PMCID: PMC6512115 DOI: 10.1161/jaha.119.012188] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background In patients with ST-segment-elevation myocardial infarction, timely reperfusion therapy with door-to-balloon (D2B) time <90 minutes is recommended by the current guidelines. However, whether further shortening of symptom onset-to-door (O2D) time or D2B time would enhance survival of patients with ST-segment-elevation myocardial infarction remains unclear. Therefore, the current study aimed to evaluate the prognostic impact of O2D or D2B time in patients with ST-segment-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Methods and Results We analyzed 5243 patients with ST-segment-elevation myocardial infarction were treated at 20 tertiary hospitals capable of primary percutaneous coronary intervention in Korea. The association between O2D or D2B time with all-cause mortality at 1 year was evaluated. The median O2D time was 2.0 hours, and the median D2B time was 59 minutes. A total of 92.2% of the total population showed D2B time ≤90 minutes. In univariable analysis, 1-hour delay of D2B time was associated with a 55% increased 1-year mortality, whereas 1-hour delay of O2D time was associated with a 4% increased 1-year mortality. In multivariable analysis, D2B time showed an independent association with mortality (adjusted hazard ratio, 1.90; 95% CI , 1.51-2.39; P<0.001). Reducing D2B time within 45 minutes showed further decreased risk of mortality compared with D2B time >90 minutes (adjusted hazard ratio, 0.30; 95% CI , 0.19-0.42; P<0.001). Every reduction of D2B time by 30 minutes showed continuous reduction of 1-year mortality (90 to 60 minutes: absolute risk reduction, 2.4%; number needed to treat, 41.9; 60 to 30 minutes: absolute risk reduction, 2.0%; number needed to treat, 49.2). Conclusions Shortening D2B time was significantly associated with survival benefit, and the survival benefit of shortening D2B time was consistently observed, even <60 to 90 minutes.
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Affiliation(s)
- Jonghanne Park
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.,2 Department of Internal Medicine Naju National Hospital Jeollanam-do Korea
| | - Ki Hong Choi
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Joo Myung Lee
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Hyun Kuk Kim
- 4 Department of Internal Medicine and Cardiovascular Center Chosun University Hospital University of Chosun College of Medicine Gwangju Korea
| | - Doyeon Hwang
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
| | - Tae-Min Rhee
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.,5 National Maritime Medical Center Changwon Korea
| | - Jihoon Kim
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Taek Kyu Park
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jeong Hoon Yang
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Young Bin Song
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jin-Ho Choi
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Joo-Yong Hahn
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Seung-Hyuk Choi
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Bon-Kwon Koo
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
| | | | - Myeong Chan Cho
- 7 Cardiology Division Department of Internal Medicine Chungbuk National University Hospital Cheongju Korea
| | - Chong Jin Kim
- 8 Department of Internal Medicine Kyunghee University College of Medicine Seoul Korea
| | - Ju Han Kim
- 9 Department of Internal Medicine and Heart Center Chonnam National University Hospital Gwangju Korea
| | - Myung Ho Jeong
- 9 Department of Internal Medicine and Heart Center Chonnam National University Hospital Gwangju Korea
| | - Hyeon-Cheol Gwon
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Hyo-Soo Kim
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
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6
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Veronese JP, Wallis L, Allgaier R, Botha R. Cardiopulmonary resuscitation by Emergency Medical Services in South Africa: Barriers to achieving high quality performance. Afr J Emerg Med 2018; 8:6-11. [PMID: 30456138 PMCID: PMC6223582 DOI: 10.1016/j.afjem.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 07/10/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Survival rates from out-of-hospital cardiac arrest significantly improve when high-quality cardiopulmonary resuscitation (CPR) is performed. Despite sudden cardiac arrest being a leading cause of death in many parts of the world, no studies have determined the quality of CPR delivery by Emergency Medical Services (EMS) personnel in South Africa. The aim of this study was to determine the quality of CPR provision by EMS staff in a simulated setting. METHODS A descriptive study design was used to determine competency of CPR among intermediate-qualified EMS personnel. Theoretical knowledge was determined using a multiple-choice questionnaire, and psychomotor skills were video-recorded then assessed by independent reviewers. Correlational and regression analysis were used to determine the effect of demographic information on knowledge and skills. RESULTS Overall competency of CPR among participants (n = 114) was poor: median knowledge was 50%; median skill 33%. Only 25% of the items tested showed that participants applied relevant knowledge to the equivalent skill, and the nature and strength of knowledge influencing skills was small. Demographic factors that significantly influenced both knowledge and skill were the sector of employment, the guidelines EMS personnel were trained to, age, experience, and the location of training. CONCLUSION Overall knowledge and skill performance was below standard. This study suggests that theoretical knowledge has a small but notable role to play on some components of skill performance. Demographic variables that affected both knowledge and skill may be used to improve training and the overall quality of Basic Life Support CPR delivery by EMS personnel.
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Affiliation(s)
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, South Africa
| | - Rachel Allgaier
- Division of Emergency Medicine, Stellenbosch University, South Africa
| | - Ryan Botha
- Faculty of Science, University of Fort Hare, South Africa
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7
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Cole J, Beare R, Phan TG, Srikanth V, MacIsaac A, Tan C, Tong D, Yee S, Ho J, Layland J. Staff Recall Travel Time for ST Elevation Myocardial Infarction Impacted by Traffic Congestion and Distance: A Digitally Integrated Map Software Study. Front Cardiovasc Med 2018; 4:89. [PMID: 29359134 PMCID: PMC5766675 DOI: 10.3389/fcvm.2017.00089] [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: 10/12/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022] Open
Abstract
Background Recent evidence suggests hospitals fail to meet guideline specified time to percutaneous coronary intervention (PCI) for a proportion of ST elevation myocardial infarction (STEMI) presentations. Implicit in achieving this time is the rapid assembly of crucial catheter laboratory staff. As a proof-of-concept, we set out to create regional maps that graphically show the impact of traffic congestion and distance to destination on staff recall travel times for STEMI, thereby producing a resource that could be used by staff to improve reperfusion time for STEMI. Methods Travel times for staff recalled to one inner and one outer metropolitan hospital at midnight, 6 p.m., and 7 a.m. were estimated using Google Maps Application Programming Interface. Computer modeling predictions were overlaid on metropolitan maps showing color coded staff recall travel times for STEMI, occurring within non-peak and peak hour traffic congestion times. Results Inner metropolitan hospital staff recall travel times were more affected by traffic congestion compared with outer metropolitan times, and the latter was more affected by distance. The estimated mean travel times to hospital during peak hour were greater than midnight travel times by 13.4 min to the inner and 6.0 min to the outer metropolitan hospital at 6 p.m. (p < 0.001). At 7 a.m., the mean difference was 9.5 min to the inner and 3.6 min to the outer metropolitan hospital (p < 0.001). Only 45% of inner metropolitan staff were predicted to arrive within 30 min at 6 p.m. compared with 100% at midnight (p < 0.001), and 56% of outer metropolitan staff at 6 p.m. (p = 0.021). Conclusion Our results show that integration of map software with traffic congestion data, distance to destination and travel time can predict optimal residence of staff when on-call for PCI.
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Affiliation(s)
- Justin Cole
- Peninsula Health Heart Service, Frankston, VIC, Australia.,Peninsula Clinical School, Monash University, Melbourne, VIC, Australia
| | - Richard Beare
- Peninsula Clinical School, Monash University, Melbourne, VIC, Australia.,Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Thanh G Phan
- School of Clinical Sciences, Monash Health, Monash University, Melbourne, VIC, Australia
| | - Velandai Srikanth
- Peninsula Clinical School, Monash University, Melbourne, VIC, Australia
| | - Andrew MacIsaac
- Department of Cardiology, St Vincent's Hospital, Melbourne, VIC, Australia
| | | | - David Tong
- Peninsula Health Heart Service, Frankston, VIC, Australia
| | - Susan Yee
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Jesslyn Ho
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Jamie Layland
- Peninsula Health Heart Service, Frankston, VIC, Australia.,Peninsula Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Cardiology, St Vincent's Hospital, Melbourne, VIC, Australia
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8
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Wah W, Pek PP, Ho AFW, Fook-Chong S, Zheng H, Loy EY, Chua TSJ, Koh TH, Chow KY, Earnest A, Pang J, Ong MEH. Symptom-to-door delay among patients with ST-segment elevation myocardial infarction in Singapore. Emerg Med Australas 2016; 29:24-32. [PMID: 27728959 DOI: 10.1111/1742-6723.12689] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Symptom-to-door time (S2D) is one of the important components of ischaemic time, which might affect the infarct size and outcomes of acute myocardial infarction. The aim of the present study was to identify patients' characteristics associated with delayed symptom-onset-to-arrival at EDs in ST-segment elevation myocardial infarction (STEMI) patients in Singapore. METHODS Retrospective data of STEMI patients presenting to the ED of all public hospitals with onsite primary percutaneous coronary intervention facilities between 2010 and 2012 were obtained from the Singapore Myocardial Infarction Registry. Based on the S2D of 120 min, characteristics of patients were compared between short S2D (≤120 min) and long S2D (>120 min). Multivariate logistic and linear regression analyses were performed. RESULTS Out of 3848 patients, 1682 patients had an S2D of ≤120 min, and 2166 had an S2D >120 min. In the multivariate analyses, older age, Malay ethnicity, diabetes mellitus, presenting symptoms of back and epigastric pain were independently associated with long S2D. Patients who utilised the emergency medical services, presented after office hours and with symptoms of chest pain, breathlessness, diaphoresis and past history of percutaneous transluminal coronary angioplasty/primary percutaneous coronary intervention, were independently associated with short S2D. Patients with long S2D had lower probability of receiving reperfusion treatment with delayed symptom-to-balloon and door-to-balloon time and higher probabilities of complications and mortality. CONCLUSION The present study shows that longer S2D was associated with older age, ethnicity, diabetes mellitus, delay in receiving early reperfusion treatment and poorer prognosis.
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Affiliation(s)
- Win Wah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Andrew Fu Wah Ho
- Emergency Medicine Residency Program, SingHealth Services, Singapore
| | | | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - En Yun Loy
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | | | - Tian Hai Koh
- Department of Cardiology, National Heart Centre, Singapore
| | - Khuan Yew Chow
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
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9
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Meloni L, Floris R, Montisci R, De Candia G, Cadeddu M, Lai G, Sori P, Ruscazio M, Pinna G, Iasiello G, Pirisi R. Care quality monitoring of a ST-segment elevation myocardial infarction programme over a 5-year period. J Cardiovasc Med (Hagerstown) 2016; 17:494-500. [DOI: 10.2459/jcm.0000000000000285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S414-35. [PMID: 26472993 DOI: 10.1161/cir.0000000000000259] [Citation(s) in RCA: 610] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Leshem-Rubinow E, Assa EB, Shacham Y, Zatelman A, Oren-Shamir A, Malov N, Golovner M, Roth A. Expediting Time from Symptoms to Medical Contact Utilizing a Telemedicine Call Center. Telemed J E Health 2015; 21:801-7. [PMID: 26431259 DOI: 10.1089/tmj.2014.0227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND No definitive solution has been forthcoming for the often dangerously long interval between symptom onset and seeking medical care in the prehospital setting. We examined the implementation of telemedicine technology and characterization of its utilizers for its efficacy in reducing this possibly life-threatening time lag. MATERIALS AND METHODS A retrospective observational study was performed on the working database of an operational telemedicine facility that included all subscribers. Time-to-contact measurements throughout 2012 were retrieved from its medical files, and data on age, gender, medical history, and main complaint were analyzed. RESULTS Throughout 2012, 22,274 of a total of 46,556 calls (47.8%) were made ≤60 min from symptom onset. It is important that 26.9% of all calls (12,522/46,556) were made in <15 min. Significantly more males (10,794/22,229 [49%]) contacted in ≤60 min compared with females (11,480/24,327 [47%], p<0.03). Subjects <60 years of age (2,889/5,717 [51%]) called earlier than those >60 years (19,386/40,839 [47%], p<0.001). Patients with prior resuscitation and/or myocardial infarction contacted significantly more rapidly than those with other cardiac diseases. Over one-half of patients with cardiac complaints contacted the call center ≤60 min from symptom onset, as did those who suffered physical trauma, but not patients with gastrointestinal symptoms or pain elsewhere. CONCLUSIONS A telemedicine system with rapid accessibility to a professional call center and prompt triage thereafter could be an additional promising strategy for shortening the interval between symptom onset and call for medical assistance. Implementation of a widespread telemedicine infrastructure may bridge the unmet gap between occurrence of symptoms to initiation of medical treatment.
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Affiliation(s)
- Eran Leshem-Rubinow
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Eyal Ben Assa
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Yacov Shacham
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | | | | | - Nomi Malov
- 2 'SHL'-Telemedicine, Israel, Tel Aviv, Israel
| | | | - Arie Roth
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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12
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Min MK, Ryu JH, Kim YI, Park MR, Park YM, Park SW, Yeom SR, Han SK, Kim YW. Does cardiac catheterization laboratory activation by electrocardiography machine auto-interpretation reduce door-to-balloon time? Am J Emerg Med 2014; 32:1305-10. [DOI: 10.1016/j.ajem.2014.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/24/2014] [Accepted: 07/26/2014] [Indexed: 11/30/2022] Open
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13
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Liu CY, Lin YN, Lin CL, Chang YJ, Hsu YH, Tsai WC, Kao CH. Cardiologist service volume, percutaneous coronary intervention and hospital level in relation to medical costs and mortality in patients with acute myocardial infarction: a nationwide study. QJM 2014; 107:557-64. [PMID: 24570479 DOI: 10.1093/qjmed/hcu044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We explore whether cardiologist service volume, hospital level and percutaneous coronary intervention (PCI) are associated with medical costs and acute myocardial infarction (AMI) mortality. METHODS From the 1997-2010 Taiwan National Health Insurance Research Database of the National Health Research Institute, we identified AMI patients and performed multiple regression analyses to explore the relationships among the different hospital levels and treatment factors. RESULTS We identified 2942 patients with AMI in medical centers and 4325 patients with AMI in regional hospitals. Cardiologist service volume, performing PCI and medical costs per patient were higher in medical centers than in regional hospitals (P < 0.0001). However, the two hospital levels did not differ significantly in in-hospital mortality (P = 0.1557). Post hoc analysis showed significant differences in in-hospital mortality rate and in medical costs among the eight groups subdivided on the basis of hospital level, cardiologist service volume, and whether PCI was performed (P < 0.001 and P = 0.001, respectively). CONCLUSIONS These results highlight the importance of encouraging hospitals to develop PCI capability and increase their cardiologist service volume after taking medical costs into account. Transferring AMI patients to hospitals with higher cardiologist service volume and PCI performed can also be very important.
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Affiliation(s)
- C-Y Liu
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Y-N Lin
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-L Lin
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Y-J Chang
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Y-H Hsu
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, C
| | - W-C Tsai
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-H Kao
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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Qureshi AI, Egila H, Adil MM, Siddiqi H, Mian N, Hassan AE, Miley JT, Rodriguez GJ, Suri MFK. “No Turn Back Approach” to Reduce Treatment Time for Endovascular Treatment of Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2014; 23:e317-23. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022] Open
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Beneficial effects of intracoronary nicorandil on microvascular dysfunction after primary percutaneous coronary intervention: demonstration of its superiority to nitroglycerin in a cross-over study. Cardiovasc Drugs Ther 2014; 27:279-87. [PMID: 23722418 DOI: 10.1007/s10557-013-6456-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE In patients undergoing primary percutaneous coronary intervention (PCI) for the treatment of ST-segment elevation myocardial infarction (STEMI), coronary microvascular dysfunction is associated with poor prognosis. Coronary microvascular resistance is predominantly regulated by ATP-sensitive potassium (KATP) channels. The aim of this study was to clarify whether nicorandil, a hybrid KATP channel opener and nitric oxide donor, may be a good candidate for improving microvascular dysfunction even when administered after primary PCI. METHODS We compared the beneficial effects of nicorandil and nitroglycerin on microvascular function in 60 consecutive patients with STEMI. After primary PCI, all patients received single intracoronary administrations of nitroglycerin (250 μg) and nicorandil (2 mg) in a randomized order; 30 received nicorandil first, while the other 30 received nitroglycerin first. Microvascular dysfunction was evaluated with the index of microcirculatory resistance (IMR), defined as the distal coronary pressure multiplied by the hyperemic mean transit time. RESULTS As a first administration, nicorandil decreased IMR significantly more than did nitroglycerin (median [interquartile ranges]: 10.8[5.2-20.7] U vs. 2.1[1.0-6.0] U, p=0.0002).As a second administration, nicorandil further decreased IMR, while nitroglycerin did not (median [interquartile ranges]: 6.0[1.3-12.7] U vs. -1.4[-2.6 to 1.3] U, p<0.0001). The IMR after the second administration was significantly associated with myocardial blush grade, angiographic TIMI frame count after the procedure, and peak creatine kinase level. CONCLUSION Intracoronary nicorandil reduced microvascular dysfunction after primary PCI more effectively than did nitroglycerin in patients with STEMI, probably via its KATP channel-opening effect.
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Elshazly MB. Letter by Elshazly Regarding Article "Primary Coronary Angioplasty for ST-Elevation Myocardial Infarction (STEMI) in Qatar: First Nationwide Program". Glob Cardiol Sci Pract 2013; 2013:80-1. [PMID: 24689003 PMCID: PMC3963724 DOI: 10.5339/gcsp.2013.9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/31/2013] [Indexed: 12/03/2022] Open
Affiliation(s)
- Mohamed B Elshazly
- Department of Medicine, Institution, Osler Residency Program, Johns Hopkins Hospital, Balimore, MD, USA
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Gershlick AH, Banning AP, Myat A, Verheugt FWA, Gersh BJ. Reperfusion therapy for STEMI: is there still a role for thrombolysis in the era of primary percutaneous coronary intervention? Lancet 2013; 382:624-32. [PMID: 23953386 DOI: 10.1016/s0140-6736(13)61454-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In the past ten years, primary percutaneous coronary intervention (PCI) has replaced thrombolysis as the revascularisation strategy for many patients presenting with ST-segment elevation myocardial infarction (STEMI). However, delivery of primary PCI within evidence-based timeframes is challenging, and health-care provision varies substantially worldwide. Consequently, even with the ideal circumstances of rapid initial diagnosis, long transfer delays to the catheter laboratory can occur. These delays are detrimental to outcomes for patients and can be exaggerated by variations in timing of patients' presentation and diagnosis. In this Series paper we summarise the value of immediate out-of-hospital thrombolysis for STEMI, and reconsider the potential therapeutic interface with a contemporary service for primary PCI. We review recent trial data, and explore opportunities for optimisation of STEMI outcomes with a pharmacoinvasive approach.
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Affiliation(s)
- Anthony H Gershlick
- Leicester Cardiovascular Biomedical Research Unit, University of Leicester, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
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18
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Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, Abella BS, Kleinman ME, Edelson DP, Berg RA, Aufderheide TP, Menon V, Leary M. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation 2013; 128:417-35. [PMID: 23801105 DOI: 10.1161/cir.0b013e31829d8654] [Citation(s) in RCA: 637] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" increased the focus on methods to ensure that high-quality cardiopulmonary resuscitation (CPR) is performed in all resuscitation attempts. There are 5 critical components of high-quality CPR: minimize interruptions in chest compressions, provide compressions of adequate rate and depth, avoid leaning between compressions, and avoid excessive ventilation. Although it is clear that high-quality CPR is the primary component in influencing survival from cardiac arrest, there is considerable variation in monitoring, implementation, and quality improvement. As such, CPR quality varies widely between systems and locations. Victims often do not receive high-quality CPR because of provider ambiguity in prioritization of resuscitative efforts during an arrest. This ambiguity also impedes the development of optimal systems of care to increase survival from cardiac arrest. This consensus statement addresses the following key areas of CPR quality for the trained rescuer: metrics of CPR performance; monitoring, feedback, and integration of the patient's response to CPR; team-level logistics to ensure performance of high-quality CPR; and continuous quality improvement on provider, team, and systems levels. Clear definitions of metrics and methods to consistently deliver and improve the quality of CPR will narrow the gap between resuscitation science and the victims, both in and out of the hospital, and lay the foundation for further improvements in the future.
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Correia LCL, Brito M, Kalil F, Sabino M, Garcia G, Ferreira F, Matos I, Jacobs P, Ronzoni L, Noya-Rabelo M. Effectiveness of a myocardial infarction protocol in reducing door-to-ballon time. Arq Bras Cardiol 2013; 101:26-34. [PMID: 23702814 PMCID: PMC3998180 DOI: 10.5935/abc.20130108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 02/14/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND An adequate door-to-balloon time (<120 minutes) is the necessary condition for the efficacy of primary angioplasty in infarction to translate into effectiveness. OBJECTIVE To describe the effectiveness of a quality of care protocol in reducing the door-to-balloon time. METHODS Between May 2010 and August 2012, all individuals undergoing primary angioplasty in our hospital were analyzed. The door time was electronically recorded at the moment the patient took a number to be evaluated in the emergency room, which occurred prior to filling the check-in forms and to the triage. The balloon time was defined as the beginning of artery opening (introduction of the first device). The first 5 months of monitoring corresponded to the period of pre-implementation of the protocol. The protocol comprised the definition of a flowchart of actions from patient arrival at the hospital, the team's awareness raising in relation to the prioritization of time, and provision of a periodic feedback on the results and possible inadequacies. RESULTS A total of 50 individuals were assessed. They were divided into five groups of 10 sequential patients (one group pre- and four groups post-protocol). The door-to-balloon time regarding the 10 cases recorded before protocol implementation was 200 ± 77 minutes. After protocol implementation, there was a progressive reduction of the door-to-balloon time to 142±78 minutes in the first 10 patients, then to 150±50 minutes, 131±37 minutes and, finally, 116±29 minutes in the three sequential groups of 10 patients, respectively. Linear regression between sequential patients and the door-to-balloon time (r = - 0.41) showed a regression coefficient of - 1.74 minutes. CONCLUSION The protocol implementation proved effective in the reduction of the door-to-balloon time.
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20
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Gehani A. Response to the letter of Elshazly. Glob Cardiol Sci Pract 2013; 2013:96-7. [PMID: 24689006 PMCID: PMC3963727 DOI: 10.5339/gcsp.2013.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 03/31/2013] [Indexed: 12/02/2022] Open
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2012; 127:e362-425. [PMID: 23247304 DOI: 10.1161/cir.0b013e3182742cf6] [Citation(s) in RCA: 1057] [Impact Index Per Article: 88.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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22
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2012; 61:e78-e140. [PMID: 23256914 DOI: 10.1016/j.jacc.2012.11.019] [Citation(s) in RCA: 2173] [Impact Index Per Article: 181.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rodríguez-Vilá O, Campos-Esteve MA. Setting Up a Population-Based Program to Optimize ST-Segment Elevation Myocardial Infarction Care. Interv Cardiol Clin 2012; 1:583-597. [PMID: 28581971 DOI: 10.1016/j.iccl.2012.06.009] [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: 11/17/2022]
Abstract
The development of ST-segment elevation myocardial infarction (STEMI) systems of care at the city, region, or nation levels has not only improved the speed of reperfusion but also enhanced the reach of primary angioplasty to areas far from percutaneous coronary intervention (PCI) centers. Setting up a STEMI system of care is a sophisticated process that requires a solid PCI hospital and emergency medical services infrastructure, disciplined collaboration, and a focus on outcomes measurement and continuous quality improvement. This article reviews the accumulated evidence supporting the development of STEMI systems of care and offers practical insights into this process.
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Affiliation(s)
- Orlando Rodríguez-Vilá
- Cardiac Catheterization Laboratories, Cardiology Section, VA Caribbean Healthcare System, 10 Casia Street, San Juan 00921, Puerto Rico; Cardiac Catheterization Laboratories, Auxilio Mutuo Hospital, 735 Ponce de Leon, Suite 503, Torre Medical Auxilio Mutuo, Hato Rey 00917, Puerto Rico.
| | - Miguel A Campos-Esteve
- Cardiac Catheterization Laboratories, Pavia Hospital, 1462 Asia Street, Santurce 00909, Puerto Rico
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Circulation: Cardiovascular Quality and Outcomes
Editors' Picks. Circ Cardiovasc Qual Outcomes 2012. [DOI: 10.1161/circoutcomes.111.964858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The following are highlights from the new series,
Circulation: Cardiovascular Quality and Outcomes
Topic Review. This series will summarize the most important manuscripts, as selected by the editors, that have published in the
Circulation
portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes and general cardiology audience. The studies included in this article represent the most significant research in the area of ST-segment elevation myocardial infarction care and address improvements in the timeliness of care, strategies for initial treatment—particularly with respect to reperfusion therapies—and trends.
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Wang YC, Lo PH, Chang SS, Lin JJ, Wang HJ, Chang CP, Hsieh LC, Chen YP, Chen WK, Chen CH, Chang KC, Hung JS. Reduced door-to-balloon times in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Int J Clin Pract 2012; 66:69-76. [PMID: 22171906 DOI: 10.1111/j.1742-1241.2011.02775.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity, particularly when door-to-balloon (D2B) time is < 90 min. We sought to minimize preventable delays by instituting an on-site cardiology team-based approach in the emergency department (ED). METHODS The on-site group comprised 146 consecutive patients with STEMI undergoing primary PCI after implementation of the on-site strategy. This new patient care model was compared with the conventional care administered before instituting the on-site cardiology team-based strategy in ED, which included 90 patients (interim group) receiving primary PCI at a catheterization room in the same building as the ED, and 147 patients (pre-on-site group) undergoing primary PCI at a catheterization room two blocks away from the ED. RESULTS Median D2B time decreased from 107 min in the pre-on-site group to 72 min in the interim group, and to 47 min in the on-site group, respectively (p < 0.001). The percentage of D2B times < 90 min increased from 34% to 78% and 96%, respectively among the three groups (p < 0.001). Hospitalization costs were significantly reduced in the on-site and interim vs. pre-on-site groups ($5944, $5999, and $6581, respectively; p = 0.008). In-hospital mortality did not differ significantly among the three groups (4.8%, 2.2%, and 6.1%, respectively; p = 0.387). CONCLUSIONS Institution of an on-site cardiology team-based approach in the ED significantly reduces D2B time in STEMI patients eligible for primary PCI.
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Affiliation(s)
- Y-C Wang
- Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
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Nestler DM, White RD, Rihal CS, Myers LA, Bjerke CM, Lennon RJ, Schultz JL, Bell MR, Gersh BJ, Holmes DR, Ting HH. Impact of Prehospital Electrocardiogram Protocol and Immediate Catheterization Team Activation for Patients With ST-Elevation–Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2011; 4:640-6. [DOI: 10.1161/circoutcomes.111.961433] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David M. Nestler
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
| | - Roger D. White
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
| | - Charanjit S. Rihal
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
| | - Lucas A. Myers
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
| | - Christine M. Bjerke
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
| | - Ryan J. Lennon
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jeffery L. Schultz
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
| | - Malcolm R. Bell
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
| | - Bernard J. Gersh
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
| | - David R. Holmes
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
| | - Henry H. Ting
- From the Departments of Emergency Medicine (D.M.N.) and Anesthesiology (R.D.W.), the Division of Cardiovascular Diseases (C.S.R., C.M.B., M.R.B., B.J.G., D.R.H., H.H.T.), Mayo Medical Transport (L.A.M., J.L.S.), and the Department of Health Sciences Research, Division of Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic College of Medicine, Rochester, MN
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Song L, Yan H, Zhao H, Wang J, Chi Y, Wu Z, Zheng B, Wang S, Peng H, Liu C, Zhou P. Improvement in door-to-balloon times in patients with ST-elevation myocardial infarction at a large urban teaching hospital in China. Int J Cardiol 2011; 153:81-2. [DOI: 10.1016/j.ijcard.2011.08.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 08/20/2011] [Indexed: 11/28/2022]
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Swensen SJ, Dilling JA, Harper CM, Noseworthy JH. The Mayo Clinic Value Creation System. Am J Med Qual 2011; 27:58-65. [DOI: 10.1177/1062860611410966] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Krumholz HM, Herrin J, Miller LE, Drye EE, Ling SM, Han LF, Rapp MT, Bradley EH, Nallamothu BK, Nsa W, Bratzler DW, Curtis JP. Improvements in door-to-balloon time in the United States, 2005 to 2010. Circulation 2011; 124:1038-45. [PMID: 21859971 DOI: 10.1161/circulationaha.111.044107] [Citation(s) in RCA: 218] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Registry studies have suggested improvements in door-to-balloon times, but a national assessment of the trends in door-to-balloon times is lacking. Moreover, we do not know whether improvements in door-to-balloon times were shared equally among patient and hospital groups. METHODS AND RESULTS This analysis includes all patients reported by hospitals to the Centers for Medicare & Medicaid Services for inclusion in the time to percutaneous coronary intervention (acute myocardial infarction-8) inpatient measure from January 1, 2005, through September 30, 2010. For each calendar year, we summarized the characteristics of patients reported for the measure, including the number and percentage in each group, the median time to primary percutaneous coronary intervention, and the percentage with time to primary percutaneous coronary intervention within 75 minutes and within 90 minutes. Door-to-balloon time declined from a median of 96 minutes in the year ending December 31, 2005, to a median of 64 minutes in the 3 quarters ending September 30, 2010. There were corresponding increases in the percentage of patients who had times <90 minutes (44.2% to 91.4%) and <75 minutes (27.3% to 70.4%). The declines in median times were greatest among groups that had the highest median times during the first period: patients >75 years of age (median decline, 38 minutes), women (35 minutes), and blacks (42 minutes). CONCLUSION National progress has been achieved in the timeliness of treatment of patients with ST-segment-elevation myocardial infarction who undergo primary percutaneous coronary intervention.
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Affiliation(s)
- Harlan M Krumholz
- Department of Internal Medicine, Yale University School of Medicine, 1 Church St, Ste 200, New Haven, CT 06510, USA.
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Brindis R, Krumholz HM. President's page: national quality initiatives put ACC's mission into action. J Am Coll Cardiol 2010; 56:1260-2. [PMID: 20883935 DOI: 10.1016/j.jacc.2010.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Whelan CT. The role of the hospitalist in quality improvement: systems for improving the care of patients with acute coronary syndrome. J Hosp Med 2010; 5 Suppl 4:S1-7. [PMID: 20842745 DOI: 10.1002/jhm.828] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Quality improvement (QI) initiatives for systems of care are vital to deliver quality care for patients with acute coronary syndrome (ACS) and hospitalists are instrumental to the QI process. Core hospitalist competencies include the development of protocols and outcomes measures that support quality of care measures established for ACS. The hospitalist may lead, coordinate, or participate in a multidisciplinary team that designs, implements, and assesses an institutional system of care to address rapid identification of patients with ACS, medication safety, safe discharge, and meeting core measures that are quality benchmarks for ACS. The use of metrics and tools such as process flow mapping and run charts can identify quality gaps and show progress toward goals. These tools may be used to assess whether critical timeframes are met, such as the time to fibrinolysis or percutaneous coronary intervention (PCI), or whether patients receive guideline-recommended medications and counseling. At the institutional level, Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) is an initiative designed to improve outcomes in elderly patients who are at higher risk for adverse events during the transition from inpatient to outpatient care. BOOST offers resources related to project management and data collection, and tools for patients and physicians. Collection and analysis of objective data are essential for documenting quality gaps or achievement of quality benchmarks. Through QI initiatives, the hospitalist has an opportunity to contribute to an institution's success beyond direct patient care, particularly as required for public disclosure of institutional performance and financial incentives promoted by regulatory agencies.
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Affiliation(s)
- Chad T Whelan
- Division of Hospital Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois, USA.
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Krumholz HM. Opportunities to improve care for patients with ST-segment elevation myocardial infarction: Focusing on how to deliver the care. Rev Esp Cardiol 2010; 63:509-12. [PMID: 20450842 DOI: 10.1016/s1885-5857(10)70110-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Krumholz HM. Oportunidades para mejorar la asistencia de los pacientes con infarto de miocardio con elevación del segmento ST: enfoque sobre la prestación de la asistencia. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70110-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ting HH, Bradley EH. Patient Education to Reduce Prehospital Delay Time in Acute Coronary Syndrome. Circ Cardiovasc Qual Outcomes 2009; 2:522-3. [DOI: 10.1161/circoutcomes.109.912188] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Henry H. Ting
- From the Knowledge and Encounter Research Unit, Division of Cardiovascular Diseases (H.H.T.), Mayo Clinic College of Medicine, Rochester, Minn; and the Division of Health Policy and Administration (E.H.B.), Yale School of Public Health, and Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Conn
| | - Elizabeth H. Bradley
- From the Knowledge and Encounter Research Unit, Division of Cardiovascular Diseases (H.H.T.), Mayo Clinic College of Medicine, Rochester, Minn; and the Division of Health Policy and Administration (E.H.B.), Yale School of Public Health, and Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Conn
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