Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.

<h4>Aim</h4>Guideline implementation programs are of paramount importance in optimizing acute ST-elevation myocardial infarction (STEMI) care. Assessment of performance indicators from a local STEMI network will provide knowledge of how to improve the system of care.<h4>Methods and...

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Autores principales:	Surya Dharma, Bambang Budi Siswanto, Isman Firdaus, Iwan Dakota, Hananto Andriantoro, Alexander J Wardeh, Arnoud van der Laarse, J Wouter Jukema
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1f4e924414884c0489356324bfec946e
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spelling	oai:doaj.org-article:1f4e924414884c0489356324bfec946e2021-11-18T08:33:14ZTemporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.1932-620310.1371/journal.pone.0086665https://doaj.org/article/1f4e924414884c0489356324bfec946e2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24520322/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Aim</h4>Guideline implementation programs are of paramount importance in optimizing acute ST-elevation myocardial infarction (STEMI) care. Assessment of performance indicators from a local STEMI network will provide knowledge of how to improve the system of care.<h4>Methods and results</h4>Between 2008-2011, 1505 STEMI patients were enrolled. We compared the performance indicators before (n = 869) and after implementation (n = 636) of a local STEMI network. In 2011 (after introduction of STEMI networking) compared to 2008-2010, there were more inter-hospital referrals for STEMI patients (61% vs 56%, p<0.001), more primary percutaneous coronary intervention (PCI) procedures (83% vs 73%, p = 0.005), and more patients reaching door-to-needle time ≤ 30 minutes (84.5% vs 80.2%, p<0.001). However, numbers of patients who presented very late (>12 hours after symptom onset) were similar (53% vs 51%, NS). Moreover, the numbers of patients with door-to-balloon time ≤ 90 minutes were similar (49.1% vs 51.3%, NS), and in-hospital mortality rates were similar (8.3% vs 6.9%, NS) in 2011 compared to 2008-2010.<h4>Conclusion</h4>After a local network implementation for patients with STEMI, there were significantly more inter-hospital referral cases, primary PCI procedures, and patients with a door-to-needle time ≤ 30 minutes, compared to the period before implementation of this network. However, numbers of patients who presented very late, the targeted door-to-balloon time and in-hospital mortality rate were similar in both periods. To improve STEMI networking based on recent guidelines, existing pre-hospital and in-hospital protocols should be improved and managed more carefully, and should be accommodated whenever possible.Surya DharmaBambang Budi SiswantoIsman FirdausIwan DakotaHananto AndriantoroAlexander J WardehArnoud van der LaarseJ Wouter JukemaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 2, p e86665 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Surya Dharma Bambang Budi Siswanto Isman Firdaus Iwan Dakota Hananto Andriantoro Alexander J Wardeh Arnoud van der Laarse J Wouter Jukema Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.
description	<h4>Aim</h4>Guideline implementation programs are of paramount importance in optimizing acute ST-elevation myocardial infarction (STEMI) care. Assessment of performance indicators from a local STEMI network will provide knowledge of how to improve the system of care.<h4>Methods and results</h4>Between 2008-2011, 1505 STEMI patients were enrolled. We compared the performance indicators before (n = 869) and after implementation (n = 636) of a local STEMI network. In 2011 (after introduction of STEMI networking) compared to 2008-2010, there were more inter-hospital referrals for STEMI patients (61% vs 56%, p<0.001), more primary percutaneous coronary intervention (PCI) procedures (83% vs 73%, p = 0.005), and more patients reaching door-to-needle time ≤ 30 minutes (84.5% vs 80.2%, p<0.001). However, numbers of patients who presented very late (>12 hours after symptom onset) were similar (53% vs 51%, NS). Moreover, the numbers of patients with door-to-balloon time ≤ 90 minutes were similar (49.1% vs 51.3%, NS), and in-hospital mortality rates were similar (8.3% vs 6.9%, NS) in 2011 compared to 2008-2010.<h4>Conclusion</h4>After a local network implementation for patients with STEMI, there were significantly more inter-hospital referral cases, primary PCI procedures, and patients with a door-to-needle time ≤ 30 minutes, compared to the period before implementation of this network. However, numbers of patients who presented very late, the targeted door-to-balloon time and in-hospital mortality rate were similar in both periods. To improve STEMI networking based on recent guidelines, existing pre-hospital and in-hospital protocols should be improved and managed more carefully, and should be accommodated whenever possible.
format	article
author	Surya Dharma Bambang Budi Siswanto Isman Firdaus Iwan Dakota Hananto Andriantoro Alexander J Wardeh Arnoud van der Laarse J Wouter Jukema
author_facet	Surya Dharma Bambang Budi Siswanto Isman Firdaus Iwan Dakota Hananto Andriantoro Alexander J Wardeh Arnoud van der Laarse J Wouter Jukema
author_sort	Surya Dharma
title	Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.
title_short	Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.
title_full	Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.
title_fullStr	Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.
title_full_unstemmed	Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.
title_sort	temporal trends of system of care for stemi: insights from the jakarta cardiovascular care unit network system.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/1f4e924414884c0489356324bfec946e
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Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.

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