Coordinated regional care of myocardial infarction in a rural area in Brazil: Minas Telecardio Project 2.

Autor:	Marino BCA; University Hospital, Universidade Federal de Minas Gerais, Rua Maranhão 1007/601, Funcionários, Belo Horizonte, MG 30150-331, Brazil.; Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Ribeiro ALP; University Hospital, Universidade Federal de Minas Gerais, Rua Maranhão 1007/601, Funcionários, Belo Horizonte, MG 30150-331, Brazil.; Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Alkmim MB; University Hospital, Universidade Federal de Minas Gerais, Rua Maranhão 1007/601, Funcionários, Belo Horizonte, MG 30150-331, Brazil., Antunes AP; University Hospital, Universidade Federal de Minas Gerais, Rua Maranhão 1007/601, Funcionários, Belo Horizonte, MG 30150-331, Brazil., Boersma E; Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands., Marcolino MS; University Hospital, Universidade Federal de Minas Gerais, Rua Maranhão 1007/601, Funcionários, Belo Horizonte, MG 30150-331, Brazil.; Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Jazyk:	angličtina
Zdroj:	European heart journal. Quality of care & clinical outcomes [Eur Heart J Qual Care Clin Outcomes] 2016 Jul 01; Vol. 2 (3), pp. 215-224.
DOI:	10.1093/ehjqcco/qcw020
Abstrakt:	Aims: In Brazil, there are considerable disparities in access to healthcare. The aim of this study was to assess how implementation of a coordinated regional management protocol for patients with ST-elevation myocardial infarction (STEMI) affected quality of care and outcomes in a rural and deprived Brazilian region with considerable social inequalities. Methods and Results: The quality of care and outcomes of STEMI was evaluated in two cohorts before (n = 214) and after (n = 143) implementation of the coordinated regional management protocol. Central to this protocol was a tablet-based digital electrocardiogram (ECG) recording in the emergency ambulance that was transmitted for analysis by trained professionals. If the pre-hospital ECG was diagnostic, it triggered a management cascade involving a direct transfer to the regional intervention centre with reperfusion by primary percutaneous coronary intervention (PPCI) or pre-hospital fibrinolysis for anticipated journey times of less than or greater than 2 h, respectively. Following implementation of the protocol, the adjusted medical delay (system delay - transport time) decreased by 40% (95% confidence intervals: -66%, -13%). The proportion of patients who received reperfusion therapy increased from 70.6 to 80.8% (P = 0.045), with increases in treatment with aspirin [94.2-100% (P = 0.003)] and P2Y12 inhibitors [87.5-100% (P < 0.001)]. The odds of in-hospital death showed a non-significant decrease [odds ratio 0.73 (95% confidence intervals: 0.34-1.60)]. Conclusion: The implementation of a coordinated regional management protocol for patients with STEMI led to marked improvements in the quality of care in a remote Brazilian region with limited resources.
Databáze:	MEDLINE
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