{"title":"能力建设和基于远程心电图的决策支持对 STEMI 患者溶栓率、住院和一年死亡率变化的影响，采用中心辐射模式；多相干预试验。","authors":"","doi":"10.1016/j.ihj.2024.06.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>We report the impact of capacity building and teleconsultation on change in the thrombolysis rates and one-year mortality in patients with STEMI using a hub and the spoke model of STEMI care.</p></div><div><h3>Methods</h3><p>Twenty secondary care public hospitals were linked with a teaching hospital as a hub centre and the impact of the intervention on change in ischemic time, thrombolysis rates and all-cause in-hospital and one-year mortality was compared.</p></div><div><h3>Results</h3><p>29 patients with STEMI were treated during pre-intervention from April 2020 to June 2020 and 255 patients during the post-intervention period from July 2020 to Oct 2021 in spoke centres. 245 patients were reported to a hub centre during the study period. The thrombolysis rate was significantly higher in the spoke centres after intervention (65.5%vs. 27.5 % <em>p</em> < 0.001) and was also significantly higher than in patients treated in a hub centre (65.5 % vs. 45.7 % <em>p</em> < 0.01). The in-hospital mortality was significantly lower in patients treated at spoke centres compared to those treated at the hub centre (7.8 % vs. 15.5 % < 0.003). The significant difference in mortality rate continued at one year (11.0 % vs.18.4 % <em>p</em> < 0.01). The median time from symptoms to thrombolytic therapy was significantly lower in STEMI patients treated in spoke centres compared to a hub centre (230 min vs. 356 min <em>p</em> < 0.001).</p></div><div><h3>Conclusion</h3><p>The hub and spoke model of STEMI care is effective in increasing thrombolysis rate, and decreasing in-hospital and one-year mortality rate.</p></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"76 3","pages":"Pages 167-171"},"PeriodicalIF":1.4000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0019483224000786/pdfft?md5=b9a05afaa1127f87d1be9229d5afe7e2&pid=1-s2.0-S0019483224000786-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Impact of capacity building and tele ECG based decision support on change in thrombolysis rate and inhospital and one year mortality in patients with STEMI, using hub and spoke model; multi-phasic intervention trial\",\"authors\":\"\",\"doi\":\"10.1016/j.ihj.2024.06.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>We report the impact of capacity building and teleconsultation on change in the thrombolysis rates and one-year mortality in patients with STEMI using a hub and the spoke model of STEMI care.</p></div><div><h3>Methods</h3><p>Twenty secondary care public hospitals were linked with a teaching hospital as a hub centre and the impact of the intervention on change in ischemic time, thrombolysis rates and all-cause in-hospital and one-year mortality was compared.</p></div><div><h3>Results</h3><p>29 patients with STEMI were treated during pre-intervention from April 2020 to June 2020 and 255 patients during the post-intervention period from July 2020 to Oct 2021 in spoke centres. 245 patients were reported to a hub centre during the study period. The thrombolysis rate was significantly higher in the spoke centres after intervention (65.5%vs. 27.5 % <em>p</em> < 0.001) and was also significantly higher than in patients treated in a hub centre (65.5 % vs. 45.7 % <em>p</em> < 0.01). The in-hospital mortality was significantly lower in patients treated at spoke centres compared to those treated at the hub centre (7.8 % vs. 15.5 % < 0.003). The significant difference in mortality rate continued at one year (11.0 % vs.18.4 % <em>p</em> < 0.01). The median time from symptoms to thrombolytic therapy was significantly lower in STEMI patients treated in spoke centres compared to a hub centre (230 min vs. 356 min <em>p</em> < 0.001).</p></div><div><h3>Conclusion</h3><p>The hub and spoke model of STEMI care is effective in increasing thrombolysis rate, and decreasing in-hospital and one-year mortality rate.</p></div>\",\"PeriodicalId\":13384,\"journal\":{\"name\":\"Indian heart journal\",\"volume\":\"76 3\",\"pages\":\"Pages 167-171\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0019483224000786/pdfft?md5=b9a05afaa1127f87d1be9229d5afe7e2&pid=1-s2.0-S0019483224000786-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian heart journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0019483224000786\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian heart journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0019483224000786","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
摘要
背景我们报告了能力建设和远程会诊对 STEMI 患者溶栓率和一年死亡率变化的影响，采用的是 STEMI 护理的 "中心-轮辐 "模式。结果干预前（2020 年 4 月至 2020 年 6 月）有 29 名 STEMI 患者在辐式中心接受治疗，干预后（2020 年 7 月至 2021 年 10 月）有 255 名患者在辐式中心接受治疗。在研究期间，有 245 名患者向中心报告。干预后，轮辐中心的溶栓率明显较高（65.5% vs. 27.5 % p < 0.001），也明显高于在枢纽中心接受治疗的患者（65.5% vs. 45.7 % p < 0.01）。在辐射中心接受治疗的患者的院内死亡率明显低于在中心接受治疗的患者（7.8% vs. 15.5% <0.003）。一年后，死亡率仍有明显差异（11.0% 对 18.4% p <0.01）。与枢纽中心相比，在辐条中心接受治疗的 STEMI 患者从出现症状到接受溶栓治疗的中位时间明显缩短（230 分钟 vs. 356 分钟 p < 0.001）。
Impact of capacity building and tele ECG based decision support on change in thrombolysis rate and inhospital and one year mortality in patients with STEMI, using hub and spoke model; multi-phasic intervention trial
Background
We report the impact of capacity building and teleconsultation on change in the thrombolysis rates and one-year mortality in patients with STEMI using a hub and the spoke model of STEMI care.
Methods
Twenty secondary care public hospitals were linked with a teaching hospital as a hub centre and the impact of the intervention on change in ischemic time, thrombolysis rates and all-cause in-hospital and one-year mortality was compared.
Results
29 patients with STEMI were treated during pre-intervention from April 2020 to June 2020 and 255 patients during the post-intervention period from July 2020 to Oct 2021 in spoke centres. 245 patients were reported to a hub centre during the study period. The thrombolysis rate was significantly higher in the spoke centres after intervention (65.5%vs. 27.5 % p < 0.001) and was also significantly higher than in patients treated in a hub centre (65.5 % vs. 45.7 % p < 0.01). The in-hospital mortality was significantly lower in patients treated at spoke centres compared to those treated at the hub centre (7.8 % vs. 15.5 % < 0.003). The significant difference in mortality rate continued at one year (11.0 % vs.18.4 % p < 0.01). The median time from symptoms to thrombolytic therapy was significantly lower in STEMI patients treated in spoke centres compared to a hub centre (230 min vs. 356 min p < 0.001).
Conclusion
The hub and spoke model of STEMI care is effective in increasing thrombolysis rate, and decreasing in-hospital and one-year mortality rate.
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.
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