Roriz Pollianna Souza, Ferreira Isabella Bonifácio Brige, Pontes Fabiana Benevides, Machado Antônio, Aguiar Tércio Caires, Matos Marcos Antônio Almeida, Paiva Filho Ivan Mattos, Menezes Rodrigo Carvalho, Andrade Bruno Bezerril
Departamento de Cardiologia, Serviço de Atendimento Móvel de Urgência (SAMU), Salvador, Brazil.
Departamento de Estimulação Cardíaca Artificial, Hospital Ana Nery, Salvador, Brazil.
Front Cardiovasc Med. 2024 Jul 22;11:1381504. doi: 10.3389/fcvm.2024.1381504. eCollection 2024.
Continuous investment and systematic evaluation of program accomplishments are required to achieve excellence in ST-segment elevation myocardial infarction (STEMI) care, especially in resource-limited settings. Therefore, this study evaluates the impact of problem-driven interventions on reperfusion use rate in a long-term operating STEMI network from a low- to middle-income country.
This is a healthcare improvement evaluation study of Salvador's public STEMI network in a quasi-experimental design, comparing data from 2009 to 2010 (pre-intervention) and 2019-2020 (post-intervention). There were evaluated all confirmed STEMI cases assisted in both periods. The interventions, implemented since 2017, included: expanding the support team, defining criteria to be a spoke, and initiating continuous education activities. The primary outcome was the rate of patients undergoing reperfusion, with secondary outcomes being time from door-to-ECG (D2E) and ECG-to-STEMI-team trigger (E2T).
Over ten years, the network's coverage increased by 300,000 individuals, and expanded by 1,800 km. A total of 885 records were analyzed, 287 in the pre-intervention group (182 men [63·4%]; mean [SD] age 62·1 [12·5] years) and 598 in the post-intervention group (356 men [59·5%]; mean [SD] age 61.9 [11·8] years). It was noticed a substantial increase in reperfusion delivery rate (90 [31%] vs. 431 [73%]; = 001) and reductions in time from D2E (159 [83-340] vs. 29 [15-63], = 001), and E2T (31 [21-44] vs. 16 [6-40], = 001).
The strategies adopted by Salvador's STEMI network were associated with significant improvements in the rate of patients undergoing reperfusion and in D2E and E2T. However, the mortality rate remains high.
要在ST段抬高型心肌梗死（STEMI）护理方面实现卓越，尤其是在资源有限的环境中，需要持续投资并对项目成果进行系统评估。因此，本研究评估了问题驱动干预措施对一个来自低收入至中等收入国家的长期运营的STEMI网络中再灌注使用率的影响。
这是一项对萨尔瓦多公共STEMI网络进行的医疗保健改进评估研究，采用准实验设计，比较2009年至2010年（干预前）和2019 - 2020年（干预后）的数据。对这两个时期内所有确诊的STEMI病例进行了评估。自2017年起实施的干预措施包括：扩大支持团队、确定作为分支的标准以及开展持续教育活动。主要结局是接受再灌注治疗的患者比例，次要结局是从入院到心电图（D2E）的时间以及心电图到STEMI团队触发（E2T）的时间。
在十年间，该网络的覆盖人数增加了30万，覆盖范围扩大了1800公里。共分析了885条记录，干预前组287条（182名男性[63.4%]；平均[标准差]年龄62.1[12.5]岁），干预后组598条（356名男性[59.5%]；平均[标准差]年龄61.9[11.8]岁）。发现再灌注治疗率大幅提高（90[31%]对431[73%]；P = 0.001），D2E时间缩短（159[83 - 340]对29[15 - 63]，P = 0.001），E2T时间缩短（31[21 - 44]对16[6 - 40]，P = 0.001）。
萨尔瓦多STEMI网络采取的策略与接受再灌注治疗的患者比例以及D2E和E2T时间的显著改善相关。然而，死亡率仍然很高。
