The result of the development of research in cardiology revealed the opportunity to implement the concept of the “golden hour” to restore coronary blood flow, which formed a new attitude to myocardial infarction with the recognition of its emergency, treatment of which requires emergency hospitalization. In recent years, a sufficient number of multicenter studies have been conducted, the data of which provided an opportunity to formulate the main strategic directions of care for patients with acute coronary syndrome and became the basis for the development of clinical guidelines by leading national and international organizations. The aim of our research was to conduct a comparative analysis of modern approaches to the treatment of acute coronary syndrome in Ukraine and abroad. The research used logical, graphical methods and the method of system analysis. The article covers modern issues of classification of acute coronary syndrome, methods of its diagnosis and treatment. Based on the results of clinical studies, global trends in the diagnosis and treatment of acute coronary syndrome are shown. The article also discusses the organization of medical care, and in particular the possibilities and problems of reperfusion therapy in the treatment of acute coronary syndrome. Analysis of literature sources and own data indicate the existence of some problems in the treatment of acute coronary syndrome, among which significant factors in high mortality are late treatment and late hospitalization. Organizational measures to improve patient awareness, early diagnosis, and early reperfusion treatment are important steps in improving the prognosis of acute coronary syndrome.
Актуальность. По данным Всемирной организации здравоохранения, в мире около 20 % людей умирает из-за отсутствия квалифицированной медицинской помощи на догоспитальном этапе, что определяет возрастание роли экстренной медицинской помощи (ЭМП) населению в системе здравоохранения. Именно поэтому обеспечение бесплатной, своевременной и эффективной медицинской помощью населения Украины при состояниях, угрожающих жизни больных, является одной из важнейших задач в сфере здравоохранения страны. Для исполнения положений Закона Украины «Об экстренной медицинской помощи» работа КУЗ «Центр экстренной медицинской помощи и медицины катастроф» (ЦЭМП и МК) Харьковской области в течение 2013–2017 гг. была направлена на улучшение показателей службы ЭМП и повышение ее качества. Цель — анализ динамики основных показателей деятельности службы ЭМП Харьковской области и разработка направлений совершенствования системы ЭМП. Материалы и методы. Проведен анализ отчетной документации учреждения «Центр экстренной медицинской помощи и медицины катастроф» Харьковской области за 2013–2017 гг. В ходе выполнения исследования использованы ретроспективный, статистический и математический методы анализа. Результаты. На сегодняшний день актуальной кадровой проблемой службы ЭМП и МК, вызванной крайне низкой материальной мотивацией, является дефицит работников. Так, согласно результатам проведенного исследования установлено, что показатель укомплектованности врачами в 2017 г. составляет 66,2 % (против 57,8 % в 2013 г.), средним медицинским персоналом — 84,7 % (против 86,0 % в 2013 г.), младшим медицинским персоналом — 73,7 % (против 82,5% в 2013 г.), водителями бригад ЭМП — 71,0 % (против 85,1 % в 2013 г.). За последние 5 лет увеличилось на 44,8 % среднесуточное количество обслуженных лиц бригадами ЭМП. При этом самый высокий уровень нагрузки приходится на врачебную общепрофильную бригаду и составляет 16,9 вызовов, самый низкий — на психиатрическую бригаду (7,7 вызова). В структуре причин вызовов в течение исследуемого периода преобладали выезды на внезапные заболевания (79,3 %) и несчастные случаи, травмы и отравления (10,4 %). При этом показатель своевременного прибытия бригад ЭМП на вызовы в городах составлял 97,8 % от общего количества экстренных вызовов, в условиях сельской местности региона — 98,1 %. Выводы. На основании результатов проведенного исследования авторами выявлены основные проблемы в организации оказания ЭМП населению и предложены основные направления ее совершенствования, что при успешной реализации позволит максимально удовлетворить потребности населения и рационально использовать все виды ресурсов системы здравоохранения.
Diseases of the circulatory system and their most severe form – acute myocardial infarction (AMI) – is one of the most important problems of modern medicine due to the steady increase in morbidity, negative impact on quality of life, early disability of patients. 19.5 % of patients die from AMI, 50 % among which die 90-120 minutes after the first symptoms of the disease. The aim of the research was to analyse the impact of hospitalization on the mortality of patients with AMI and predict the risk of death in case of untimely hospitalization of this category of patients. Materials and methods. We have conducted a retrospective analysis of 876 medical records of patients diagnosed with AMI who were treated in the cardiology department of Kharkiv Regional Clinical Hospital in 2019. During the study, we have used retrospective, logical, medical and statistical methods. Odds ratios and a 95 % confidence interval were also calculated. Results and discussion. The research revealed the impact of hospitalization on the organization of medical care and hospital mortality of patients with AMI. It was found that the largest share of patients with AMI, both among the dead and those who left the hospital, were hospitalized in the period from 2 to 12 hours from the onset of the disease (49.6 % and 52.33 %, respectively), as well as in period after 24 hours – 28.00 % and 21.70 %, respectively. The largest share of patients with AMI, regardless of the time of hospitalization were persons older than 60 years. The results of the analysis showed that in the period up to 2 h from the onset of the disease, the share of hospitalized patients with more severe heart muscle damage (presence of Q wave) was 91.35 % against 8.65 % of patients with AMI without ST segment elevation. It should be noted that in almost 50 % of cases, patients with AMI without ST segment elevation were hospitalized after 24 h from the onset of the disease. At the same time, the largest share of deaths in this group of patients was observed in the hospital stay from 12 to 24 hours. According to the results of the research, risk factors for fatal outcome in AMI were identified, in particular male gender, the presence of an established ECG diagnosis of NSTEMI, conducting SKA in patients with AMI. It was also found that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %. Conclusions. The obtained data indicate a strong relationship between the time of hospitalization and the organization of medical care and hospital mortality of patients with AMI. It is reliably established that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %: HS is 0.483 (95 % CI 0.238 – 0.981), p=0.175.
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