Organisational management of the time-dependent network for the treatment of acute coronary syndrome.

Introduction: Cardiovascular diseases are the leading cause of death in Italy, being responsible for 227,350 deaths in 2020, according to the National Institute of Statistics. The implementation of timely reperfusion therapy is crucial to improve patient outcomes, and time-dependent networks for the treatment of Acute Coronary Syndrome, particularly ST-elevation myocardial infarction, have been established. In Tuscany, the network for the treatment of Acute Coronary Syndrome-ST-elevation myocardial infarction covers a vast area encompassing three Local Health Authorities, including all of South-Eastern Tuscany. Key features include equity of access, patient safety, improving the quality of care, standardization, the enhancement of professional skills, technological innovation, increasing case volumes and multi-professional integration across emergency services, hospital facilities and primary care networks. The Tuscan Acute Coronary Syndrome network provides comprehensive treatment for Acute Coronary Syndrome-ST-elevation myocardial infarction in 12 hospitals with 24-hour hemodynamics laboratories and has been extended to new territories, namely Piombino and the Island of Elba. The aim of the present study was to assess the impact of an analytical system for monitoring times to reperfusion treatment and subsequent actions, in order to improve the performance of the network.

Materials and methods: In this retrospective study, we conducted an analytical evaluation of the network's performance, including reperfusion treatment times and factors causing delay. The study utilized data on patient transport, times from symptom onset to medical contact, and outcomes from the National Outcomes Program (NOP; "Programma Nazionale Esiti" in Italian). Analytical evaluations in 2021 measured the network's overall performance and identified the main causes of delay. The treatment process was divided into periods, from symptom onset to coronary reperfusion; interventions such as public awareness campaigns, electrocardiogram tele-transmission, and fast-track transfers were implemented in order to minimize delays.

Results: The lowest 30-day mortality rate in Acute Coronary Syndrome patients was recorded in hospitals that treated over 300 cases annually, according to the 2020 and 2021 National Outcomes Program of. Improvements continued into 2022 and 2023, with mortality rates also declining in patients initially admitted to peripheral hospitals. Among residents of Piombino and the Island of Elba, 30-day mortality decreased from 8.8% (2017-2020) to 5.7% in 2022. In 2022, the Grosseto Hub treated 80% of ST-elevation myocardial infarction patients within 90 minutes.

Conclusions: The establishment of a well-organized time-dependent network for the treatment of Acute Coronary Syndrome-ST-elevation myocardial infarction in Tuscany significantly improved patient outcomes, thus demonstrating the critical role of timely and efficient care pathways. Our network's success is attributable to several factors, including improved accessibility, enhanced coordination among healthcare facilities, and the efficient use of technology and resources. These findings highlight the importance of structured clinical-care pathways in delivering high-quality care for Acute Coronary Syndrome patients.