Role of primary care physicians in treating patients with ST-segment elevation myocardial infarction located in remote areas (from the REseau Nord-Alpin des Urgences [RENAU], Network)

Yayehd, Komlavi; Ricard, C.; Ageron, François-Xavier; Buscaglia, Léna; Savary, Dominique; Audema, Bernard; Lacroix, Dan; Barthes, Manuela; Joubert, Patrick; Gheno, G.; Belle, Loïc

doi:10.1177/2048872614544856

Cited by 8 publications

(11 citation statements)

References 31 publications

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“…To improve EtoCCLA time, direct activation of CCL by ED physicians or an available on-site cardiologist is recommended [13]. Direct activation of CCL by ED physicians increased the rate of false-positive activation to 9-39%, resulting in unnecessary procedures and medical resources, while an on-site cardiologist is not always available, especially in regional hospi-tals, and rural or remote areas [27][28][29]. The AI-S provides both diagnostic quality and cost effectiveness with fairly feasible, noninvasive, and inexpensive characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Second, ECG machines in ambulances can be modified to facilitate telemedicine, which may reduce physician resources and loading and provide early CCLA to shorten DtoB time. Third, it may be applied in rural and remote areas and places lacking experts for ECG interpretation to promote diagnostic accuracy, thereby facilitating timely management [28,29].…”

Section: Discussionmentioning

confidence: 99%

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An Artificial Intelligence-Based Alarm Strategy Facilitates Management of Acute Myocardial Infarction

Liu

Lin

Tsai

et al. 2021

JPM

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(1) Background: While an artificial intelligence (AI)-based, cardiologist-level, deep-learning model for detecting acute myocardial infarction (AMI), based on a 12-lead electrocardiogram (ECG), has been established to have extraordinary capabilities, its real-world performance and clinical applications are currently unknown. (2) Methods and Results: To set up an artificial intelligence-based alarm strategy (AI-S) for detecting AMI, we assembled a strategy development cohort including 25,002 visits from August 2019 to April 2020 and a prospective validation cohort including 14,296 visits from May to August 2020 at an emergency department. The components of AI-S consisted of chest pain symptoms, a 12-lead ECG, and high-sensitivity troponin I. The primary endpoint was to assess the performance of AI-S in the prospective validation cohort by evaluating F-measure, precision, and recall. The secondary endpoint was to evaluate the impact on door-to-balloon (DtoB) time before and after AI-S implementation in STEMI patients treated with primary percutaneous coronary intervention (PPCI). Patients with STEMI were alerted precisely by AI-S (F-measure = 0.932, precision of 93.2%, recall of 93.2%). Strikingly, in comparison with pre-AI-S (N = 57) and post-AI-S (N = 32) implantation in STEMI protocol, the median ECG-to-cardiac catheterization laboratory activation (EtoCCLA) time was significantly reduced from 6.0 (IQR, 5.0–8.0 min) to 4.0 min (IQR, 3.0–5.0 min) (p < 0.01). The median DtoB time was shortened from 69 (IQR, 61.0–82.0 min) to 61 min (IQR, 56.8–73.2 min) (p = 0.037). (3) Conclusions: AI-S offers front-line physicians a timely and reliable diagnostic decision-support system, thereby significantly reducing EtoCCLA and DtoB time, and facilitating the PPCI process. Nevertheless, large-scale, multi-institute, prospective, or randomized control studies are necessary to further confirm its real-world performance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An Artificial Intelligence-Based Alarm Strategy Facilitates Management of Acute Myocardial Infarction

Liu

Lin

Tsai

et al. 2021

JPM

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“…The RESURCOR network disseminates protocols via pocket cards and booklets, available at a dedicated website (www.renau.org). An ongoing regional prospective registry of STEMI patients has provided data since 2002 on the acute phase of patient care [11–15].…”

Section: Methodsmentioning

confidence: 99%

Early inter-hospital transfer of patients with myocardial infarction without a doctor, paramedic or nurse on board: results from a French regional emergency care network

Cassan¹,

Rata

Vallenet³

et al. 2019

BMC Emerg Med

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BackgroundIn France, patients with acute coronary syndromes (ACS) are usually transferred from remote hospitals to percutaneous coronary intervention (PCI) centres in mobile intensive care units (MICUs) with on-board medical staff. They are then returned to the remote hospitals by MICU 48 h after PCI. However, MICU transportation and beds in a PCI centre are in short supply. Therefore, we investigated clinical outcomes among intermediate-risk ACS patients who were transferred in private ambulances without an on-board medic or paramedic; and returned to the remote hospital sooner after PCI.MethodsIn the French Alps, the RESURCOR network manages ‘SCA-Alp’ transfers using strict management protocols in ambulances with trained drivers and automatic external defibrillators, but without heart rhythm monitoring. We conducted an observational retrospective study that assessed outcomes (death and emergency return to the PCI centre within 48 h) in patients transferred using SCA-Alp. Our population comprised stabilized patients with ST-segment elevation myocardial infarction (STEMI) who returned to the remote hospital within 24–48 h of PCI, and uncomplicated patients with non-ST-segment elevation myocardial infarction (NSTEMI) within 24–72 h of symptom onset who come from and returned to (‘round-trip’) the remote hospital on the day of PCI (return < 12 h after PCI).ResultsBetween 2010 and 2014, 101 STEMI and 490 NSTEMI patients were transferred using SCA-Alp. No adverse events occurred during transportation and no deaths were reported. Two of 591 patients (0.3% [95% confidence interval 0.1–1.4%]) experienced a stent thrombosis within 48 h of PCI that required a second urgent PCI; both were event free at 6-month follow-up.ConclusionsInter-hospital transfer using SCA-Alp is associated with low event rates in intermediate-risk ACS patients, allowing a more streamlined use of medical facilities and freeing-up of beds in PCI centres.

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“…Most previous studies focused on the association between transfer modes ( 12 ), delay time, and mortality among patients with STEMI ( 3 , 13 – 15 ). Although some researchers explored the role of general practitioners/primary healthcare physicians in treating patients with STEMI in remote areas ( 16 ), the influence of the quality and quantity of healthcare professionals on transfer delay and in-hospital mortality have received little attention. Currently, China is facing problems associated with scarcity and uneven distribution of healthcare professionals for pre-hospital EMS.…”

Section: Introductionmentioning

confidence: 99%

Quantity and Quality of Healthcare Professionals, Transfer Delay and In-hospital Mortality Among ST-Segment Elevation Myocardial Infarction: A Mixed-Method Cross-Sectional Study of 89 Emergency Medical Stations in China

Zhou¹,

Tian

Wu³

et al. 2022

Front. Public Health

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BackgroundTransfer delay provokes prolongation of prehospital time, which contributes to treatment delay that endangers patients with ST-segment elevation myocardial infarction (STEMI). A key constraint in reducing transfer delay is the shortage of emergency healthcare workers. This study was to explore the influence of the quality and quantity of healthcare professionals at emergency medical stations on transfer delay and in-hospital mortality among STEMI patients.MethodsA cross-sectional study using mixed methods was conducted at 89 emergency stations in 9 districts in China's Shenzhen province. Based on a sample of 31 hospitals, 1,255 healthcare professionals, and 3,131 patients with STEMI, a generalized linear model was used to explore the associations between the quality and quantity of healthcare professionals and transfer delay and in-hospital mortality among STEMI patients. Qualitative data were collected and analyzed to explore the reasons for the lack of qualified healthcare professionals at emergency medical stations.ResultsThe analysis of the quantity of healthcare professionals showed that an increase of one physician per 100,000 individuals was associated with decreased transfer delay for patients with STEMI by 5.087 min (95% CI −6.722, −3.452; P < 0.001). An increase of one nurse per 100,000 individuals was associated with decreased transfer delay by 1.471 min (95% CI −2.943, 0.002; P=0.050). Analysis of the quality of healthcare professionals showed that an increase of one physician with an undergraduate degree per 100,000 individuals was associated with decreased transfer delay for patients with STEMI by 8.508 min (95% CI −10.457, −6.558; P < 0.001). An increase of one nurse with an undergraduate degree per 100,000 individuals was associated with decreased transfer delay by 6.645 min (95% CI −8.218, −5.072; P < 0.001). Qualitative analysis illustrated that the main reasons for low satisfaction of healthcare professionals at emergency medical stations included low income, limited promotion opportunities, and poor working environment.ConclusionsThe quantity and quality of emergency healthcare professionals are key factors influencing transfer delay in STEMI patients. The government should increase the quantity of healthcare professionals at emergency medical stations, strengthen the training, and improve their performance by linking with clinical pathways to enhance job enthusiasm among emergency healthcare professionals.

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Role of primary care physicians in treating patients with ST-segment elevation myocardial infarction located in remote areas (from the REseau Nord-Alpin des Urgences [RENAU], Network)

Abstract: PCP care of STEMI patients located in isolated areas appears efficient, with high rates of resuscitation and thrombolysis and a shorter delay to reperfusion.

Cited by 8 publications

References 31 publications

An Artificial Intelligence-Based Alarm Strategy Facilitates Management of Acute Myocardial Infarction

An Artificial Intelligence-Based Alarm Strategy Facilitates Management of Acute Myocardial Infarction

Early inter-hospital transfer of patients with myocardial infarction without a doctor, paramedic or nurse on board: results from a French regional emergency care network

Quantity and Quality of Healthcare Professionals, Transfer Delay and In-hospital Mortality Among ST-Segment Elevation Myocardial Infarction: A Mixed-Method Cross-Sectional Study of 89 Emergency Medical Stations in China

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