Regional system of care for ST-segment elevation myocardial infarction in the Northern Alps: A controlled pre- and postintervention study
| Autor: | Benoît Vallet, José Labarère, Loic Belle, Julien Brallet, Nicolas Danchin, David Delgado, Gérald Vanzetto, Guillaume Debaty, Magali Fourny, Fast-Mi investigators |
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| Přispěvatelé: | BCM, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble, CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Radiopharmaceutiques biocliniques, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), SAMU, Service de cardiologie [CHU Rouen], Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU) |
| Jazyk: | angličtina |
| Předmět: |
Male
medicine.medical_treatment 030204 cardiovascular system & hematology Regional Medical Programs Coronary Angiography Health Services Accessibility 0302 clinical medicine MESH: Myocardial Reperfusion MESH: Fibrinolytic Agents 030212 general & internal medicine Myocardial infarction Outcome and process assessment Prospective cohort study MESH: Cohort Studies MESH: Aged Emergency medical services MESH: Health Services Accessibility MESH: Middle Aged Hazard ratio General Medicine Middle Aged MESH: Case-Control Studies 3. Good health MESH: Myocardial Infarction MESH: Intervention Studies MESH: Emergency Medical Services Cohort studies Female France Cardiology and Cardiovascular Medicine Études de cohorte MESH: Percutaneous Coronary Intervention Cohort study Services d’urgence medicine.medical_specialty Évaluation des processus et des résultats Myocardial Reperfusion Infarctus du myocarde 03 medical and health sciences Reperfusion therapy Percutaneous Coronary Intervention Fibrinolytic Agents Internal medicine Réseaux de soins Fibrinolysis medicine Humans Aged Retrospective Studies MESH: Humans business.industry Percutaneous coronary intervention Retrospective cohort study MESH: Retrospective Studies medicine.disease MESH: Male MESH: Coronary Angiography Surgery MESH: France Case-Control Studies MESH: Regional Medical Programs Regional medical programmes [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie business MESH: Female |
| Zdroj: | Archives of cardiovascular diseases Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2012, 105 (8-9), pp.414-23. ⟨10.1016/j.acvd.2012.05.001⟩ |
| ISSN: | 1875-2136 |
| DOI: | 10.1016/j.acvd.2012.05.001 |
| Popis: | International audience; BACKGROUND: Regionalization of care for ST-segment elevation myocardial infarction (STEMI) has been advocated, although its effect on processes of care and clinical outcomes remains uncertain. AIM: To assess the impact of a regional system of care on provision of reperfusion therapy for STEMI patients relative to control hospitals. METHODS: We analysed the original data from two nationwide prospective cohort studies conducted in 2000 and 2005, respectively. Overall, 160 hospitals participated in both studies, including seven hospitals involved in a regional system of care implemented in the Northern Alps in 2002 and 153 control hospitals located in other French areas. RESULTS: A total of 102 and 2377 STEMI patients were enrolled in Northern Alps and control hospitals, respectively. Overall, patients enrolled in 2005 were more likely to receive any reperfusion therapy (60% vs 52%; P < 0.001), prehospital fibrinolysis (33% vs 15%; P < 0.001), and primary percutaneous coronary intervention (32% vs 26%; P < 0.001) than those enrolled in 2000. However, the regional system of care was associated with a larger absolute change in the use of prehospital fibrinolysis (45.0 vs 17.0; P = 0.02) and rescue or early routine coronary angiography or intervention after fibrinolysis (35.3 vs 15.2; P = 0.01). Patients enrolled in 2005 had lower adjusted hazard ratios for death (0.70, 95% confidence interval 0.57-0.87; P = 0.001), with no significant interaction between study groups. CONCLUSION: Regionalization of care for STEMI patients improves access to reperfusion therapy, although its impact on clinical outcomes deserves further study. |
| Databáze: | OpenAIRE |
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