Nadeem Qamar, Jawaid A. Sial, Tahir Sagir, Zair Hussain, Ali Zain Shah, Kamran Khan, Jehangir Ali Shah, Musa Karim, Shueeta Kumari, Sohail Khan, Sabha Bhatti, Abdul Hakeem
{"title":"在人口稠密的低收入和中等收入国家（LMICs）推进急性心肌梗死护理：创新的独立胸痛室可实现快速分流和及时管理","authors":"Nadeem Qamar, Jawaid A. Sial, Tahir Sagir, Zair Hussain, Ali Zain Shah, Kamran Khan, Jehangir Ali Shah, Musa Karim, Shueeta Kumari, Sohail Khan, Sabha Bhatti, Abdul Hakeem","doi":"10.1016/j.lansea.2024.100488","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The incidence of myocardial infarction (MI) and its adverse effects on health and mortality remain high in densely populated low- and middle-income countries (LMICs). To address the issue of densely populated areas and timely access to primary PCI, chest pain units (CPUs) were deployed at strategic locations in Karachi, with a populace of over 23 million people. This study describes the results of this initiative in expediting MI care.</div></div><div><h3>Methods</h3><div>Between 2017 and 2023, 18 CPUs, each with a cardiologist, technician, ECG machine, crash cart and an ambulance were placed in high density areas.</div></div><div><h3>Findings</h3><div>A total of 915,564 patients were seen at 18 CPUs over the study period. 692,444 (75.6%) were categorized as non-cardiac and subsequently discharged. 223,120 (24.6%) patients were directed for additional care. Of these, 9% had ST elevation myocardial infarction (STEMI) (19, 580), 29% NSTE ACS/Unstable angina, and 31% with various other cardiac conditions. Additionally, 31% were referred for medical outpatient evaluation. CPU inception led to a significant annual growth (16–20%) in primary PCI procedures at NICVD, totaling 20,000 by 2022–2023. The median first medical contact to device time was 100 min (IQR 80–135), while total ischemic was 232 min (IQR: 172–315; 5th −95th %le: 50–920). The overall in-hospital mortality rate for patients undergoing primary PCI was 5.58%, with a range between 5.1% and 6.9% through the study period.</div></div><div><h3>Interpretation</h3><div>Novel standalone chest pain units, operational from 2017 in Karachi, Pakistan, have expedited triage and enhanced the timely management of AMI. This initiative's transformative impact presents a model that resonates beyond borders, serving as a role model for global healthcare systems.</div></div><div><h3>Funding</h3><div>The CPU and primary PCI program is fully funded by the <span>government of Sindh</span>. No specific funding was allocated for this study.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"30 ","pages":"Article 100488"},"PeriodicalIF":5.0000,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Advancing acute MI care in densely populated low- and middle-income countries (LMICs): innovative stand-alone chest pain units for expedited triage and timely management\",\"authors\":\"Nadeem Qamar, Jawaid A. Sial, Tahir Sagir, Zair Hussain, Ali Zain Shah, Kamran Khan, Jehangir Ali Shah, Musa Karim, Shueeta Kumari, Sohail Khan, Sabha Bhatti, Abdul Hakeem\",\"doi\":\"10.1016/j.lansea.2024.100488\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The incidence of myocardial infarction (MI) and its adverse effects on health and mortality remain high in densely populated low- and middle-income countries (LMICs). To address the issue of densely populated areas and timely access to primary PCI, chest pain units (CPUs) were deployed at strategic locations in Karachi, with a populace of over 23 million people. This study describes the results of this initiative in expediting MI care.</div></div><div><h3>Methods</h3><div>Between 2017 and 2023, 18 CPUs, each with a cardiologist, technician, ECG machine, crash cart and an ambulance were placed in high density areas.</div></div><div><h3>Findings</h3><div>A total of 915,564 patients were seen at 18 CPUs over the study period. 692,444 (75.6%) were categorized as non-cardiac and subsequently discharged. 223,120 (24.6%) patients were directed for additional care. Of these, 9% had ST elevation myocardial infarction (STEMI) (19, 580), 29% NSTE ACS/Unstable angina, and 31% with various other cardiac conditions. Additionally, 31% were referred for medical outpatient evaluation. CPU inception led to a significant annual growth (16–20%) in primary PCI procedures at NICVD, totaling 20,000 by 2022–2023. The median first medical contact to device time was 100 min (IQR 80–135), while total ischemic was 232 min (IQR: 172–315; 5th −95th %le: 50–920). The overall in-hospital mortality rate for patients undergoing primary PCI was 5.58%, with a range between 5.1% and 6.9% through the study period.</div></div><div><h3>Interpretation</h3><div>Novel standalone chest pain units, operational from 2017 in Karachi, Pakistan, have expedited triage and enhanced the timely management of AMI. This initiative's transformative impact presents a model that resonates beyond borders, serving as a role model for global healthcare systems.</div></div><div><h3>Funding</h3><div>The CPU and primary PCI program is fully funded by the <span>government of Sindh</span>. 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Advancing acute MI care in densely populated low- and middle-income countries (LMICs): innovative stand-alone chest pain units for expedited triage and timely management
Background
The incidence of myocardial infarction (MI) and its adverse effects on health and mortality remain high in densely populated low- and middle-income countries (LMICs). To address the issue of densely populated areas and timely access to primary PCI, chest pain units (CPUs) were deployed at strategic locations in Karachi, with a populace of over 23 million people. This study describes the results of this initiative in expediting MI care.
Methods
Between 2017 and 2023, 18 CPUs, each with a cardiologist, technician, ECG machine, crash cart and an ambulance were placed in high density areas.
Findings
A total of 915,564 patients were seen at 18 CPUs over the study period. 692,444 (75.6%) were categorized as non-cardiac and subsequently discharged. 223,120 (24.6%) patients were directed for additional care. Of these, 9% had ST elevation myocardial infarction (STEMI) (19, 580), 29% NSTE ACS/Unstable angina, and 31% with various other cardiac conditions. Additionally, 31% were referred for medical outpatient evaluation. CPU inception led to a significant annual growth (16–20%) in primary PCI procedures at NICVD, totaling 20,000 by 2022–2023. The median first medical contact to device time was 100 min (IQR 80–135), while total ischemic was 232 min (IQR: 172–315; 5th −95th %le: 50–920). The overall in-hospital mortality rate for patients undergoing primary PCI was 5.58%, with a range between 5.1% and 6.9% through the study period.
Interpretation
Novel standalone chest pain units, operational from 2017 in Karachi, Pakistan, have expedited triage and enhanced the timely management of AMI. This initiative's transformative impact presents a model that resonates beyond borders, serving as a role model for global healthcare systems.
Funding
The CPU and primary PCI program is fully funded by the government of Sindh. No specific funding was allocated for this study.
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