Aim: Rural patients have higher cardiovascular death rates and poorer access to cardiac services compared to the metropolitan population 1 . NSW now has four regional Cardiac Catheter Labs. These do not have 24/7 PCI services, mandating some patients still be transferred to city centres. We examined the ability of the Orange Catheter service, providing angiography 4 days a week and stenting on Fridays, to comprehensively manage ACS patients. The impact on length of stay and cost was compared with two other rural base hospitals that transferred patients to Sydney for angiography from July 2007 to June 08.Results: During this time, 403 inpatients underwent angiography at Orange, 189 were managed medically, 140 were stented locally, 74 were transferred to Sydney, more than half for CABG. Of all ACS patients 82% were fully managed locally with transport cost savings of $1.2million (approx). The average LOS (length of stay) for ACS patients in Orange was 3.39 days comparing favourably with statewide benchmarks (A1 peer hospital 3.7days and B1 6.0). The average LOS for ACS patients transferred to Sydney hospitals from 2 other rural base hospitals during the same year was 4.2 and 3.8 days. Patients transferred to Orange for angiography from these sites had a shorter LOS (2.8 and 2.4 days).Conclusion: Rural Catheter Labs improve access to cardiac services and provide a cost effective, safe 2 and convenient service for patients. Earlier cardiac catheterisation is achieved, allowing triage of patients based on their anatomy. A large percentage of patients are fully managed locally.
Background: Reperfusion strategies for STEMIs are time-critical. Timely PPCI is preferred although thrombolysis remains effective especially within the "Golden Hour". QAS PHT was introduced in February 2008-potentially providing a significant impact on early delivery of reperfusion therapy and forcing a reevaluation of time-delay intervals for thrombolysis and PPCI. Current PAH reperfusion protocol for STEMIs involves expedited QAS transfer to the cardiac catheterization laboratory for PPCI in-hours (07:00-18:00) and QAS PHT out-of-hours (18:00-07:00 and weekends) or if lab delays exist.
Methods: We analysed all patients who underwent PPCI (15) or received PHT (16) from February 2008 to 2009 at PAH.Results: Baseline mean ages were significantly different (PPCI 61.3 ± 10.0 years vs PHT 51.0 ± 8.4 years, P = 0.004). TIMI risk score was 2.4 ± 1.7 for PPCI and 1.7 ± 1.1 for PHT (P = 0.17). Time-delay to PPCI (defined as time from QAS call on-site to balloon inflation/export catheter) was 61.1 ± 15.5 min. For PHT, time from 1st qualifying ECG to needle was 19.3 ± 13.6 min. PPCI was unsuccessful in 1 patient and 5 patients failed thrombolysis requiring rescue PCI. Even including delays with rescue PCI, there was no statistically significant difference in total ischemic time (PPCI 174 ± 104 min vs PHT 213 ± 115 min, P = 0.30). Mean ejection fraction was 43 ± 14% with PPCI and 48 ± 13% for PHT (P = 0.27). Length of stay was similar (PPCI 3.8 ± 1.1 days vs PHT 4.0 ± 0.8 days, P = 0.56).Conclusion: Availability of PHT resets the "door-toballoon" time window for PPCI. Our time-delays to PPCI in-hours fall within the existing guidelines. Given expected delays with out-of-hours PPCI, PHT in the current protocol appears to be a reasonable approach.Background: Point of care (POC) testing for cardiac markers increase turn around times in patients with potential acute coronary syndrome (ACS), enabling diag-
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.