Forsyth René, Sun Zhonghua, Reid Christopher, Moorin Rachael
Discipline of Medical Radiation Sciences, Curtin University, Perth, WA 6102, Australia.
School of Public Health, NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Perth, WA 6102, Australia.
J Clin Med. 2020 Dec 25;10(1):49. doi: 10.3390/jcm10010049.
Acute coronary syndrome (ACS) is globally recognised as a significant health burden, for which the reduction in total ischemic times by way of the most suitable reperfusion strategy has been the focus of national and international initiatives. In a setting such as western Australia, characterised by 79% of the population dwelling in the greater capital region, transfers to hospitals capable of percutaneous coronary intervention (PCI) is often a necessary but time-consuming reality for outer-metropolitan and rural patients.
Hospital separations, emergency department admissions and death registration data between 1 January 2007 and 31 December 2015 were linked by the Western Australian Data Linkage Unit, identifying patients with a confirmed first-time diagnosis of ACS, who were either a direct admission or experienced an inter-hospital transfer.
Although the presentation rates of ACS remained stable over the nine years evaluated, the rates of first-time admissions for ACS were more than double in the rural residential cohort, including higher rates of ST-segment elevation myocardial infarction, the most time-critical manifestation of ACS. Consequently, rural patients were more likely to undergo an inter-hospital transfer. However, 42% of metropolitan admissions for a first-time ACS also experienced a transfer.
While the time burden of inter-hospital transfers for rural patients is a reality in health care systems where it is not feasible to have advanced facilities and workforce skills outside of large population centres, there is a concerning trend of inter-hospital transfers within the metropolitan region highlighting the need for further initiatives to streamline pre-hospital triage to ensure patients with symptoms indicative of ACS present to PCI-equipped hospitals.
急性冠状动脉综合征（ACS）在全球范围内被公认为是一项重大的健康负担，通过最合适的再灌注策略减少总缺血时间一直是国内外举措的重点。在西澳大利亚这样的地区，79%的人口居住在大首府地区，对于大都市外围和农村地区的患者来说，转至有能力进行经皮冠状动脉介入治疗（PCI）的医院往往是必要但耗时的现实情况。
西澳大利亚数据链接部门将2007年1月1日至2015年12月31日期间的医院出院、急诊科入院和死亡登记数据进行了关联，确定了首次确诊为ACS的患者，这些患者要么是直接入院，要么经历了医院间的转诊。
尽管在评估的九年中ACS的就诊率保持稳定，但农村居住人群中首次因ACS入院的比率增加了一倍多，包括ST段抬高型心肌梗死（ACS最紧急的表现形式）的比率更高。因此，农村患者更有可能接受医院间的转诊。然而，首次因ACS入院的大都市患者中也有42%经历了转诊。
在医疗系统中，对于农村患者来说，医院间转诊的时间负担是一个现实情况，因为在大型人口中心以外配备先进设施和专业技能的医疗人员并不可行，而大都市地区医院间转诊的趋势令人担忧，这凸显了需要采取进一步举措来简化院前分诊，以确保有ACS症状的患者能够前往配备PCI的医院就诊。
