Temporal trends of system of care for STEMI: insights from the jakarta cardiovascular care unit network system

Abstract

Aim: Guideline implementation programs are of paramount importance in optimizing acute ST-elevation myocardial infarction (STEMI) care. Assessment of performance indicators from a local STEMI network will provide knowledge of how to improve the system of care. Between 2008Between -2011Between , 1505 STEMI patients were enrolled. We compared the performance indicators before (n = 869) and after implementation (n = 636) of a local STEMI network. In 2011 (after introduction of STEMI networking) compared to 2008-2010, there were more inter-hospital referrals for STEMI patients (61% vs 56%, p,0.001), more primary percutaneous coronary intervention (PCI) procedures (83% vs 73%, p = 0.005), and more patients reaching door-to-needle time #30 minutes (84.5% vs 80.2%, p,0.001). However, numbers of patients who presented very late (.12 hours after symptom onset) were similar (53% vs 51%, NS). Moreover, the numbers of patients with door-to-balloon time #90 minutes were similar (49.1% vs 51.3%, NS), and in-hospital mortality rates were similar (8.3% vs 6.9%, NS) in 2011 compared to 2008-2010. Conclusion: After a local network implementation for patients with STEMI, there were significantly more inter-hospital referral cases, primary PCI procedures, and patients with a door-to-needle time #30 minutes, compared to the period before implementation of this network. However, numbers of patients who presented very late, the targeted door-toballoon time and in-hospital mortality rate were similar in both periods. To improve STEMI networking based on recent guidelines, existing pre-hospital and in-hospital protocols should be improved and managed more carefully, and should be accommodated whenever possible. Methods and Results:Citation: Dharma S, Siswanto BB, Firdaus I, Dakota I, Andriantoro H, et al. (2014) Temporal Trends of System of Care for STEMI: Insights from the Jakarta Cardiovascular Care Unit Network System. PLoS ONE 9(2): e86665.

Reperfusion therapy of myocardial infarction in Mexico: A challenge for modern cardiology

“…In 2014 Dharma and colleagues shared the experience of the implementation of a networked system of cardiovascular care in Jakarta, Indonesia. 20 Interventions included a community education program in basic life support, placement of automated external defibrillators (AED) in strategic locations, designing and using a system of pre-hospital electrocardiograms, a transfer protocol and specific inhospital practices to reduce delays in reperfusion. After a year of program implementation, researchers reported an increase in interhospital referrals of patients with STEMI (greater awareness of medical personnel about STEMI), greater number of angioplasties (83% vs. 73%, p = 0.005) and more patients reaching a door-to-needle time under 30 min (84.5% vs. 80.2%, p < 0.001).…”

Door-to-balloon Time in Cardiovascular Emergency Care in a Hospital of Northern Brazil

“…In a multicenter study conducted in public and private hospitals in Brazil, Wang et al, 3 found that 64.04% of 633 patients with STEMI showed a door-to-balloon time longer than 90 minutes. Dharma et al, 14 in a study carried out in Jakarta, Indonesia, reported that 51.3% of 263 STEMI patients had an inadequate door-to-balloon time. These findings emphasize the difficulty in achieving a satisfactory door-to-balloon time in the management of STEMI patients.…”

“Door-In to Door-Out” Delay in Patients with Acute ST-Segment Elevation Myocardial Infarction Transferred for Primary Percutaneous Coronary Intervention in a Metropolitan STEMI Network of a Developing Country

“…The JAC registry has been used widely as the main source of data for measuring the performance of the STEMI network in Jakarta, Indonesia. [11][12][13]…”