A System of Care for Patients With ST-Segment Elevation Myocardial Infarction in India

Alexander, Thomas; Mullasari, Ajit S.; Joseph, George; Kannan, K.; Veerasekar, Ganesh; Victor, Suma M.; Ayers, Colby; Thomson, Viji Samuel; Subban, Vijayakumar; Gnanaraj, Justin Paul; Narula, Jagat; Kumbhani, Dharam J.; Nallamothu, Brahmajee K.

doi:10.1001/jamacardio.2016.5977

Cited by 73 publications

(72 citation statements)

References 27 publications

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“…The Kovai Erode Pilot developed a system of care based on a hub-and-spoke model, with regional STEMI clusters connecting remotely located healthcare centres with large PCI hubs, using a model that combines PPCI with the pharmacoinvasive strategy 24. The improved access to PPCI or pharmacoinvasive approach with reduction of 1-year mortality24 led to the expansion of the model to a broader region 35. In Brazil, the Minas Telecardio 2 Project involved stakeholders and hospitals, prehospital units and the prehospital ambulance service of a remote region.…”

Section: Possible Strategies To Improve MI Care In Lmicsmentioning

confidence: 99%

Implementing myocardial infarction systems of care in low/middle-income countries

Nascimento

Brant

Marino

et al. 2018

Heart

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Ischaemic heart disease is the leading cause of death worldwide, with an increasing trend from 6.1 million deaths in 1990 to 9.5 million in 2016, markedly driven by rates observed in low/middle-income countries (LMIC). Improvements in myocardial infarction (MI) care are crucial for reducing premature mortality. We aimed to evaluate the main challenges for adequate MI care in LMIC, and possible strategies to overcome these existing barriers.Reperfusion is the cornerstone of MI treatment, but worldwide around 30% of patients are not reperfused, with even lower rates in LMIC. The main challenges are related to delays associated with patient education, late diagnosis and inadequate referral strategies, health infrastructure and insufficient funding. The implementation of regional MI systems of care in LMIC, systematising timely reperfusion strategies, access to intensive care, risk stratification and use of adjunctive medications have shown some successful strategies. Telemedicine support for remote ECG, diagnosis and organisation of referrals has proven to be useful, improving access to reperfusion even in prehospital settings. Organisation of transport and referral hubs based on anticipated delays and development of MI excellence centres have also resulted in better equality of care. Also, education of healthcare staff and task shifting may potentially widen access to optimal therapy.In conclusion, efforts have been made for the implementation of MI systems of care in LMIC, aiming to address particularities of the health systems. However, the increasing impact of MI in these countries urges the development of further strategies to improve reperfusion and reduce system delays.

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Section: Possible Strategies To Improve MI Care In Lmicsmentioning

confidence: 99%

Implementing myocardial infarction systems of care in low/middle-income countries

Nascimento

Brant

Marino

et al. 2018

Heart

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“…Employing a hub-and-spoke model, the Tamil Nadu-STEMI study 6 was a multicenter, prospective study of 2,420 patients conducted between August 2012 and January 2013. In this study, an integrated health care network linking 35 spoke health care centers to 4 large hub hospitals capable of providing percutaneous coronary intervention (PCI) was examined using a pre- and post-implementation study design.…”

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confidence: 99%

“…The investigators found that postfibrinolysis angiography and primary PCI were more commonly performed and one-year, risk-adjusted mortality was lower following implementation. 6 A key feature explicating the TN-STEMI program was the use of an integrated team of providers – paramedics, nurses and physicians – who leveraged health information technology to facilitate real-time clinical and ECG data transmission to hospitals. 6 The ‘STEMI toolkit’ hardware included a vital signs and ECG recording device that facilitated transmission of timely information from paramedics to STEMI coordinators at hub hospitals and a hand-held device that enabled communication amongst STEMI coordinators and on-call cardiologists.…”

mentioning

confidence: 99%

“…6 A key feature explicating the TN-STEMI program was the use of an integrated team of providers – paramedics, nurses and physicians – who leveraged health information technology to facilitate real-time clinical and ECG data transmission to hospitals. 6 The ‘STEMI toolkit’ hardware included a vital signs and ECG recording device that facilitated transmission of timely information from paramedics to STEMI coordinators at hub hospitals and a hand-held device that enabled communication amongst STEMI coordinators and on-call cardiologists. 6 Unique software applications streamlined the communication across multiple devices amongst all team members.…”

mentioning

confidence: 99%

“…6 The ‘STEMI toolkit’ hardware included a vital signs and ECG recording device that facilitated transmission of timely information from paramedics to STEMI coordinators at hub hospitals and a hand-held device that enabled communication amongst STEMI coordinators and on-call cardiologists. 6 Unique software applications streamlined the communication across multiple devices amongst all team members. In this manner, the TN-STEMI program effectively utilized a team of providers to leverage technological innovation and facilitate timely reperfusion therapy.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Confluence of Cultural Context and Technological Innovation to Reduce Cardiovascular Disparities in India

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Prabhakaran

Chopra

2017

Circ: Cardiovascular Quality and Outcomes

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Improving Evidence for Implementation of Guideline-Based Care in Low- and Middle-Income Countries

Granger

Xavier

2018

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Coronary heart disease is the number one cause of death and disability in India and around the world. 1 Evidence-based approaches for prevention and treatment of coronary heart disease are widely available but are not used optimally, particularly in low-and middleincome countries. 2,3 In India, like in many countries, there are major gaps between actual and ideal care, and quality of care is substantially worse for patients with low socioeconomic status. 4 Studies of quality improvement in Brazil, 5 China, 6 and India 7 have been associated with improvements in acute coronary syndrome care [5][6][7] and in clinical outcomes. 7 However, there is an important need to further develop approaches to improve implementation of evidence-based care in these countries.Certain principles apply to implementing guidelines in any health care setting, as summarized by reviews of the evidence of what has been shown to be effective. 8 Effective strategies have been multifaceted, as there are numerous aspects to implementation such that any one element, such as physician reminders or a care pathway, is unlikely to make a large difference. Audit and feedback are important, and data collection is essential: if implementation strategies and outcomes are not measured, they cannot be improved. Targeted interactive education such as with outreach visits by experts from outside the practice setting is important.The interventions must also be customized to account for the barriers of the local health care setting. Understanding the gaps and barriers is a requirement for developing effective interventions in any health care system. In India, barriers to optimal care of acute coronary syndromes vary by region. These include financial barriers for patients and their families, transportation limitations in both rural (lack of transportation modes) and urban (heavy traffic) settings, lack of sophisticated emergency medical services, and inadequate integrated information systems to track patients through systems of care. Solutions have included use of cell phones for efficient transfer of information, including to patients and their families, and use of nonphysician health care workers to educate patients and their families, especially after discharge from the hospital, when use of effective treatments begins to wane. 9 Progressively more rigorous approaches have been developed for generation of evidence regarding what works for implementing guidelines. Most quality improvement programs have used a pre/post design, in which performance and outcomes are measured over time as an intervention to improve care is implemented. Although this use of a "historical control" group can be compelling, secular trends in both

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A System of Care for Patients With ST-Segment Elevation Myocardial Infarction in India

Abstract: A hub-and-spoke model in South India improved STEMI care through greater use of PCI and may improve 1-year mortality. This model may serve as an example for developing STEMI systems of care in other low- to middle-income countries.

Cited by 73 publications

References 27 publications

Implementing myocardial infarction systems of care in low/middle-income countries

Implementing myocardial infarction systems of care in low/middle-income countries

Confluence of Cultural Context and Technological Innovation to Reduce Cardiovascular Disparities in India

Improving Evidence for Implementation of Guideline-Based Care in Low- and Middle-Income Countries

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