Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal Pub Date : 2025-03-01 DOI:10.1016/j.ihj.2025.02.004

Guruprasad Naik , Amar Prabhudesai , Venkatesh Malali , Michelle Viegas Parab , Joel Quadros , Pankajam Vaidya , Edward D'Mello , Swapnil Arsekar , Radha Valaulikar

{"title":"Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges","authors":"Guruprasad Naik , Amar Prabhudesai , Venkatesh Malali , Michelle Viegas Parab , Joel Quadros , Pankajam Vaidya , Edward D'Mello , Swapnil Arsekar , Radha Valaulikar","doi":"10.1016/j.ihj.2025.02.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>To study the impact of a ‘hub and spoke’ STEMI management programme on delivery of thrombolysis in the state of Goa.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted to assess the ‘hub and spoke’ model STEMI programme in the state of Goa. Data was collected using predesigned proformas filled at Primary Health Centres or District Hospitals which served as the spokes. Primary programme efficacy outcomes studied were the proportion of eligible patients of STEMI receiving thrombolysis and the time to thrombolysis. Secondary outcome assessed was in-hospital mortality.</div></div><div><h3>Results</h3><div>A total of 2050 number of patients were diagnosed with STEMI between November 2019 and March 2022, of which complete data was available for 1325 patients. After ruling out contraindications, delayed presentations or refusal for treatment, 74.3 % of STEMI patients received thrombolysis. The median window period was 130.83 min with an interquartile range (IQR) of 159.63 min. The median time from presentation to recording ECG was 7.9 (IQR = 11.63) minutes and presentation to cloud diagnosis was 11.78 (IQR = 12.96) minutes. The median time from presentation to administering thrombolysis (Door to Needle time) was 18.48 (IQR = 28.85) minutes. Only 0.22 % patients received inappropriate thrombolysis and the in-hospital mortality was 9.4 %.</div></div><div><h3>Conclusion</h3><div>A STEMI programme utilizing the existing manpower and primary health care setup improved ‘secondary’ level of care to patients by providing thrombolysis to a high percentage of patients in quick time. This may serve as a model to improve the outreach of reperfusion therapy in a resource challenged country like India.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"77 2","pages":"Pages 67-72"},"PeriodicalIF":1.4000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian heart journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0019483225000136","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

To study the impact of a ‘hub and spoke’ STEMI management programme on delivery of thrombolysis in the state of Goa.

Methods

A prospective observational study was conducted to assess the ‘hub and spoke’ model STEMI programme in the state of Goa. Data was collected using predesigned proformas filled at Primary Health Centres or District Hospitals which served as the spokes. Primary programme efficacy outcomes studied were the proportion of eligible patients of STEMI receiving thrombolysis and the time to thrombolysis. Secondary outcome assessed was in-hospital mortality.

Results

A total of 2050 number of patients were diagnosed with STEMI between November 2019 and March 2022, of which complete data was available for 1325 patients. After ruling out contraindications, delayed presentations or refusal for treatment, 74.3 % of STEMI patients received thrombolysis. The median window period was 130.83 min with an interquartile range (IQR) of 159.63 min. The median time from presentation to recording ECG was 7.9 (IQR = 11.63) minutes and presentation to cloud diagnosis was 11.78 (IQR = 12.96) minutes. The median time from presentation to administering thrombolysis (Door to Needle time) was 18.48 (IQR = 28.85) minutes. Only 0.22 % patients received inappropriate thrombolysis and the in-hospital mortality was 9.4 %.

Conclusion

A STEMI programme utilizing the existing manpower and primary health care setup improved ‘secondary’ level of care to patients by providing thrombolysis to a high percentage of patients in quick time. This may serve as a model to improve the outreach of reperfusion therapy in a resource challenged country like India.

查看原文本刊更多论文

中心辐式STEMI果阿项目的实施——初步成果、收获和挑战。

目的：研究果阿邦“轮辐式”STEMI管理方案对溶栓服务的影响。方法：进行了一项前瞻性观察研究，以评估果阿邦的“枢纽和辐条”模式STEMI计划。数据是使用预先设计的表格收集的，这些表格是在初级保健中心或地区医院填写的。研究的主要方案疗效结果是STEMI患者接受溶栓治疗的比例和溶栓时间。评估的次要结局是住院死亡率。结果：2019年11月至2022年3月，共有2050例患者被诊断为STEMI，其中1325例患者可获得完整数据。在排除禁忌症、延迟就诊或拒绝治疗后，74.3%的STEMI患者接受了溶栓治疗。中位窗期为130.83min，四分位间距（IQR）为159.63min。从首发到记录心电图的中位时间为7.9 （IQR=11.63）分钟，从首发到云诊断的中位时间为11.78 （IQR=12.96）分钟。从出现到给药溶栓的中位时间（门到针时间）为18.48 （IQR=28.85）分钟。不适当溶栓率仅为0.22%，住院死亡率为9.4%。结论：STEMI方案利用现有人力和初级卫生保健机构，通过快速为高比例的患者提供溶栓治疗，改善了对患者的“二级”护理水平。这可以作为一个模式，以提高再灌注治疗的外延在资源匮乏的国家，如印度。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Indian heart journal CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.60

自引率

6.70%

发文量

审稿时长

52 days

期刊介绍： Indian Heart Journal (IHJ) is the official peer-reviewed open access journal of Cardiological Society of India and accepts articles for publication from across the globe. The journal aims to promote high quality research and serve as a platform for dissemination of scientific information in cardiology with particular focus on South Asia. The journal aims to publish cutting edge research in the field of clinical as well as non-clinical cardiology - including cardiovascular medicine and surgery. Some of the topics covered are Heart Failure, Coronary Artery Disease, Hypertension, Interventional Cardiology, Cardiac Surgery, Valvular Heart Disease, Pulmonary Hypertension and Infective Endocarditis. IHJ open access invites original research articles, research briefs, perspective, case reports, case vignette, cardiovascular images, cardiovascular graphics, research letters, correspondence, reader forum, and interesting photographs, for publication. IHJ open access also publishes theme-based special issues and abstracts of papers presented at the annual conference of the Cardiological Society of India.