在人口稠密的低收入和中等收入国家（LMICs）推进急性心肌梗死护理：创新的独立胸痛室可实现快速分流和及时管理

IF 5 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet regional health. Southeast Asia Pub Date : 2024-09-30 DOI:10.1016/j.lansea.2024.100488

Nadeem Qamar, Jawaid A. Sial, Tahir Sagir, Zair Hussain, Ali Zain Shah, Kamran Khan, Jehangir Ali Shah, Musa Karim, Shueeta Kumari, Sohail Khan, Sabha Bhatti, Abdul Hakeem

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引用次数: 0

摘要

背景在人口稠密的中低收入国家，心肌梗死（MI）的发病率及其对健康和死亡率的不利影响仍然很高。为了解决人口稠密地区和及时获得初级 PCI 的问题，我们在卡拉奇的战略要地部署了胸痛室 (CPU)，卡拉奇的人口超过 2300 万。本研究介绍了这一举措在加快心肌梗死护理方面取得的成果。方法在 2017 年至 2023 年期间，在高密度地区部署了 18 个胸痛室，每个胸痛室配备一名心脏病专家、技术人员、心电图机、急救车和一辆救护车。研究结果在研究期间，18 个胸痛室共接诊了 915,564 名患者。692,444人（75.6%）被归类为非心脏病患者，随后出院。223,120（24.6%）名患者接受了额外护理。其中，9% 患有 STEMI（ST 段抬高型心肌梗死）（19，580），29% 患有 NSTE ACS/不稳定型心绞痛，31% 患有其他各种心脏疾病。此外，31%的患者被转诊至医疗门诊进行评估。中央处理器启动后，NICVD 的初级 PCI 手术量每年大幅增长（16%-20%），到 2022-2023 年，总手术量将达到 20,000 例。首次医疗接触到设备的中位时间为 100 分钟（IQR 80-135），缺血总时间为 232 分钟（IQR：172-315；第 5 -95 百分位数：50-920）。在整个研究期间，接受初级 PCI 治疗的患者的总体院内死亡率为 5.58%，范围在 5.1% 到 6.9% 之间。释义巴基斯坦卡拉奇从 2017 年开始运行的新型独立胸痛室加快了分流速度，加强了对急性心肌梗死的及时管理。这一举措的变革性影响提供了一种超越国界的模式，为全球医疗保健系统树立了榜样。资金支持CPU和初级PCI项目由信德省政府全额资助。本研究未获得专项拨款。

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Advancing acute MI care in densely populated low- and middle-income countries (LMICs): innovative stand-alone chest pain units for expedited triage and timely management

Background

The incidence of myocardial infarction (MI) and its adverse effects on health and mortality remain high in densely populated low- and middle-income countries (LMICs). To address the issue of densely populated areas and timely access to primary PCI, chest pain units (CPUs) were deployed at strategic locations in Karachi, with a populace of over 23 million people. This study describes the results of this initiative in expediting MI care.

Methods

Between 2017 and 2023, 18 CPUs, each with a cardiologist, technician, ECG machine, crash cart and an ambulance were placed in high density areas.

Findings

A total of 915,564 patients were seen at 18 CPUs over the study period. 692,444 (75.6%) were categorized as non-cardiac and subsequently discharged. 223,120 (24.6%) patients were directed for additional care. Of these, 9% had ST elevation myocardial infarction (STEMI) (19, 580), 29% NSTE ACS/Unstable angina, and 31% with various other cardiac conditions. Additionally, 31% were referred for medical outpatient evaluation. CPU inception led to a significant annual growth (16–20%) in primary PCI procedures at NICVD, totaling 20,000 by 2022–2023. The median first medical contact to device time was 100 min (IQR 80–135), while total ischemic was 232 min (IQR: 172–315; 5th −95th %le: 50–920). The overall in-hospital mortality rate for patients undergoing primary PCI was 5.58%, with a range between 5.1% and 6.9% through the study period.

Interpretation

Novel standalone chest pain units, operational from 2017 in Karachi, Pakistan, have expedited triage and enhanced the timely management of AMI. This initiative's transformative impact presents a model that resonates beyond borders, serving as a role model for global healthcare systems.