Abstract 213: Treatment Delays in Patients with ST-Elevation Myocardial Infarction Across All Hospitals Performing Primary Percutaneous Coronary Intervention in Quebec, Canada: Results of a Third Field Evaluation
Notice bibliographique
Résumé
Background: Our government-funded independent cardiology evaluation unit conducted a third systematic province-wide field evaluation of ST-elevation myocardial infarction (STEMI) in collaboration with an interdisciplinary committee of clinical experts. Primary percutaneous coronary intervention (PPCI) is the predominant reperfusion treatment for STEMI in Quebec and in 2 previous evaluations (2006-7; 2008-9), there were wide variations in treatment delays across the 13 PPCI hospitals. Initiatives to improve delays have included individualized hospital report cards, presentations and discussions of inter-regional analyses with clinicians and decision-makers and the province-wide implantation of an ambulance (prehospital) ECG program. Our objective was to describe the differences in STEMI processes of care over time that these initiatives may have produced. Methods: Medical charts of all patients with a final diagnosis of acute myocardial infarction who presented with characteristic symptoms to an emergency department (ED) during a 6-month period in 2013-2014 were reviewed. Trained medical record librarians collected data on clinical characteristics and time points of care. An automated algorithm was used to identify STEMI. All patients with STEMI who presented directly to the ED of one of the 13 PPCI centers (by ambulance or other means) and were treated with PPCI were included in this preliminary analysis. ECGs were reviewed at our core laboratory. Results: During the 6-month study period, 735 patients with STEMI presented directly to the ED of a PPCI hospital (including ambulance bypass of local non-PPCI hospitals) and were treated with PPCI. Center patient volume varied from 29 to 117. Over 80% (596/735) of the patients arrived by ambulance (up from 71% in 2009-9) and of these, 93% (552/596) had a prehospital ECG compared with 20% in 2008-9. The median ED door-in-door-out delay was 26 min (10-90th percentile: 8-72) compared with 49 min (17-126) in 2008-9 (p=0.001). The median door-to-device delay was 59 min (30-125), compared with 77 min (38-163) during 2008-9 (p=0.017), and varied from a median of 38 to 87 min across the 13 PPCI hospitals. For patients arriving by ambulance with documented first medical contact time, 48% (260/541) had a first medical contact-to-device time ≤ 90 min compared with 35% in 2008-9 (p=0.06). Conclusions: This third province-wide evaluation shows important improvements in Quebec’s system of STEMI care. Since 2008-9, ED door-in-door-out delay improved by 47% and door-to-device delay for direct admission PPCI improved by 23%. These improvements have occurred after local, regional and provincial efforts to monitor and reduce treatment delays and the implantation of a province-wide prehospital ECG program. However, the wide variation in delays across PPCI centers underlines the need for continued evaluation and improvement initiatives.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».