德国认证胸痛中心急性冠状动脉综合征和持续性ST段抬高患者的非工作时间与工作时间护理情况对比
On versus off-hour care of patients with acute coronary syndrome and persistent ST-segment elevation in certified German chest pain units.
作者信息
Breuckmann Frank, Hochadel Matthias, Voigtländer Thomas, Haude Michael, Schmitt Claus, Münzel Thomas, Giannitsis Evangelos, Mudra Harald, Heusch Gerd, Schumacher Burghard, Barth Sebastian, Schuler Gerhard, Hailer Birgit, Walther Dirk, Senges Jochen
机构信息
1 Department of Cardiology, Arnsberg Medical Center, Germany.
2 Institute for Myocardial Infarction Research, Germany.
出版信息
Eur Heart J Acute Cardiovasc Care. 2017 Feb;6(1):3-9. doi: 10.1177/2048872615624845. Epub 2016 Sep 22.
BACKGROUND
Regional healthcare projects improve the off-hour care of patients with acute coronary syndromes and persistent ST-segment elevation myocardial infarction (STEMI). To analyse differences in quality of care between on and off-hour care of STEMI patients admitted to certified German chest pain units.
METHODS
A total of 1107 STEMI patients from the German chest pain unit registry were enrolled. Analyses comprised critical time intervals (symptoms to first medical contact (FMC), FMC to admission, symptoms to admission, symptoms to balloon, FMC to balloon, door to balloon times) and major adverse cardiac and cerebrovascular events at follow-up.
RESULTS
54.8% of patients were admitted off-hours. Symptoms to admission (2:28 (1:28-5:20 h) vs. 3:16 h (1:35-8:06 h), P<0.001), symptoms to FMC (1:15 h (0:33-3:00 h) vs. 2:00 h (0:40-6:46 h), P<0.001) and FMC to admission intervals (0:45 h (0:30-1:20 h) vs. 0:52 h (0:32-1:35 h), P=0.09) were shorter during off-hours. Percutaneous revascularisation rates were high and without difference between on and off-hours (95.5% vs. 96.8%, P=0.30). Door to balloon times were significantly less during on-hours (0:32 h (0:18-1:06 h) vs. 0:44 h (0:23-1:20 h), P<0.01) without negative impact on the proportion of patients with a door to balloon time of <60 min (72.6% vs. 68.4%, P=0.19), symptoms to balloon (3:49 h (2:12-10:46 h) vs. 3:30 h (2:04-7:41 h), P=0.08) or FMC to balloon times (1:26 h (0:56-2:22 h) vs. 1:30 h (1:03-2:29 h), P=0.14). Major adverse cardiac and cerebrovascular event rates did not differ significantly between on and off-hours (log-rank test P=0.36).
CONCLUSIONS
The German chest pain unit network ensures rapid and structured preclinical and in-hospital care independent from the circadian variation of admission. Slower door to balloon times off-hours are compensated by faster symptoms to admission or symptoms to FMC intervals. Further efforts should focus on patient awareness programmes on-hours and STEMI alarming tracks off-hours.
背景
区域医疗保健项目改善了急性冠状动脉综合征和持续性ST段抬高型心肌梗死（STEMI）患者的非工作时间护理。分析德国认证胸痛单元收治的STEMI患者在工作时间和非工作时间护理质量的差异。
方法
共纳入德国胸痛单元登记处的1107例STEMI患者。分析包括关键时间间隔（症状出现至首次医疗接触（FMC）、FMC至入院、症状出现至入院、症状出现至球囊扩张、FMC至球囊扩张、门至球囊扩张时间）以及随访时的主要不良心脑血管事件。
结果
54.8%的患者在非工作时间入院。非工作时间症状出现至入院时间（2:28（1:28 - 5:20小时）对3:16小时（1:35 - 8:06小时），P<0.001）、症状出现至FMC时间（1:15小时（0:33 - 3:00小时）对2:00小时（0:40 - 6:46小时），P<0.001）和FMC至入院间隔时间（0:45小时（0:30 - 1:20小时）对0:52小时（0:32 - 1:35小时），P = 0.09）较短。经皮血管重建率较高，工作时间和非工作时间之间无差异（95.5%对96.8%，P = 0.30）。工作时间门至球囊扩张时间显著更短（0:32小时（0:18 - 1:06小时）对0:44小时（0:23 - 1:20小时），P<0.01），但对门至球囊扩张时间<60分钟的患者比例无负面影响（72.6%对68.4%，P = 0.19）、症状出现至球囊扩张时间（3:49小时（2:12 - 10:46小时）对3:3小时（（2:04 - 7:41小时），P = 0.08）或FMC至球囊扩张时间（1:26小时（0:56 - 2:22小时）对1:30小时（1:03 - 2:29小时），P = 0.14）。工作时间和非工作时间的主要不良心脑血管事件发生率无显著差异（对数秩检验P = 0.36）。
结论
德国胸痛单元网络确保了快速且结构化的院前和院内护理，不受入院时间的昼夜变化影响。非工作时间较慢的门至球囊扩张时间通过更快的症状出现至入院或症状出现至FMC间隔时间得到补偿。进一步的努力应集中在工作时间的患者意识项目和非工作时间的STEMI警报跟踪上。
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