ANALYSIS OF ORGANIZATIONAL COMPONENTS OF EMERGENCY MEDICAL CARE FOR PATIENTS WITH ACUTE CORONARY SYNDROME IN POLTAVA REGION OF UKRAINE

2021 ◽  
Vol 8 (2) ◽  
pp. 90-99
Author(s):  
Vyacheslav M. Zhdan ◽  
Iryna A. Holovanova ◽  
Grygori A. Oksak ◽  
Maksym V. Khorosh
Keyword(s):  
Acute Coronary Syndrome ◽  
Medical Care ◽  
Rural Areas ◽  
Emergency Medical Care ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Emergency Medical ◽  
St Segment ◽  
Number Of Patients ◽  
The One

The aim of our research was to study the structure of patients with acute coronary syndrome and determine the organizational components of medical care for patients with suspected acute coronary syndrome in Poltava region. Material and methods: For our study was on the one hand statistical reports of health care institutions for 2016-2018, and on the other – a survey of doctors and paramedics of emergency medical care teams on tactics management of patients with AMI. The methodological apparatus used to achieve the set goals was based on the determination of relative values and analysis of time series. Results: The number of patients hospitalized with acute coronary syndrome is growing every year: from 82 people in 2012 to 489 in 2018. According to the monitoring conducted in Poltava region, emergency medical care for patients with acute coronary syndrome with ST segment elevation in 2018 in the cities was provided in the amount of 717, while in rural areas – 288. Conclusions: Data from the analysis of emergency medical care for patients with acute coronary syndrome showed that among patients with ST-segment elevation, urban residents predominate; in 90.6% of cases, the time to the patient’s hospitalization was less than 120 minutes.

Comparative Anticoagulant Therapy Of Acute Coronary Syndrome Without St-Segment Elevation In Young Men

2021 ◽  
Vol 03 (02) ◽  
pp. 68-71
Author(s):  
F. O. Khasanjanova ◽  
◽  
E. N. Tashkenbaeva ◽  
N. N. Radjabov ◽  
G. H. Khalilov ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Medical Care ◽  
Anticoagulant Therapy ◽  
Comparative Effectiveness ◽  
Young Men ◽  
Emergency Medical Care ◽  
Scientific Center ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

The comparative effectiveness of enoxiparin sodium and non-fractional heparin (NPH) in the treatment of acute coronary syndrome (ACS) in young men was studied. 100 patients with ACS were examined on the basis of the Samarkand branch of the Republican Scientific Center for Emergency Medical Care from 2018 to 2020. The average age of the patients was 34±5 years. The patients were divided into 2 groups. The first group consisted of 54 men who received anticoagulant therapy with enoxiparin sodium at a dose of 1 mg / kg after 12 hours of 0.5 mg/kg. The second group consisted of 46 men who received NSF, with the first dose of 10,000 units administered intravenously by bolus, and then-5000 units 6 hours subcutaneously.

scholarly journals Changing in the profile of a patient with acute coronary syndrome without ST-segment elevation over the years 2015-2020

2021 ◽  
Vol 26 (4) ◽  
pp. 94-98
Author(s):  
O.S. Shchukina
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Laboratory ◽  
Clinical Status ◽  
High Sensitivity ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Number Of Patients ◽  
Noteworthy Feature ◽  
Risk Patients

The article represents an analysis of the dynamics of the main demographic, clinical, laboratory, and instrumental investigations, final diagnoses of patients who were hospitalized with a diagnosis of acute coronary syndrome without ST segment elevation. A distinctive feature of the work is the recruitment of patients in the same medical institution for different periods of time, which makes possible to trace the dynamics of the clinical profile of patients in the population of Dnipro, a large industrial center of Ukraine. The prevalence of arterial hypertension, chronic heart failure and previous myocardial infarction remained at the same level. In the 2017-2020’s group compared with the 2015’s group, electrocardiographic  manifestations of acute coronary syndrome without ST-segment elevation upon admission were more often detected. Laboratory indicators such as hemoglobin, creatinine and total cholesterol levels remained the same. Another interesting finding is a statistically significant decrease in the number of patients with a reduced glomerular filtration rate according to MDRD (less than 60 ml/min/1.73 m2) in the 2017-2020’s group compared to patients in 2015’s group, although the clinical course of the disease remained practically unchanged. There was a trend towards a worsening of the clinical status and prognosis, namely, increase in the prevalence of atrial fibrillation and diabetes mellitus, increase in the risk of GRACE, as well as increase in the quantity of verified diagnoses of unstable angina, which is most likely associated with the increased use of high-sensitivity troponin. Noteworthy feature is that increase in the quantity of high-risk patients led to an increase in the mean GRACE score.

scholarly journals Analysis of pharmacotherapy of patients with acute coronary syndrome at pre-hospital stage

2020 ◽  
pp. 42-45
Author(s):  
E. Yu. Eryomina ◽  
K. A. Sveshnikov ◽  
M. I. Lityushkina
Keyword(s):  
Acute Coronary Syndrome ◽  
Medical Care ◽  
Fibrinolytic Therapy ◽  
Time Of Arrival ◽  
Narcotic Analgesics ◽  
St Segment Elevation ◽  
Diagnostic Measures ◽  
Coronary Syndrome ◽  
St Segment ◽  
The Moment

A patient with acute coronary syndrome requires not only urgent hospitalization, continuous medical observation, but also medical and diagnostic measures that meet standard standards.Purpose of the study. Аnalysis of the management of patients with acute coronary syndrome with ST segments elevation in the prehospital phase.Materials and methods. Analysis of emergency medical care patients with acute coronary syndrome with ST-segment elevation in 2017. In the study group, men (126 people) and women (119 people).Results. The average time of arrival of the team is 14 minutes, the total time of patient care is 28.9 minutes (excluding time for delivery to the hospital). The time from the call to the moment of delivery to the emergency department is 53 minutes. Analysis of drug therapy revealed that the frequency of nitrates was 88.8 %, antiplatelet therapy – 88.2 %, narcotic analgesics – 82.3 %, anticoagulants – 67.3 %, β-blockers – 18.7 %, oxygen therapy – 36.3 %, antiarrhythmic drugs – 6.4 %, fibrinolytic therapy was performed in 54.3 % of patients.Conclusions. А patient with acute coronary syndrome with ST elevation segments in the prehospital hospital provided sufficient medical care in accordance with clinical guidelines. A low percentage of thrombolytic therapy is associated with the presence of absolute contraindications for the patient.

scholarly journals Treatment of patients with acute coronary syndrome in 2019 (data from federal registry of acute coronary syndrome)

2020 ◽  
pp. 37-45
Author(s):  
О.В. Сагайдак ◽  
Е.В. Ощепкова ◽  
Ю.В. Попова ◽  
О.М. Посненкова ◽  
А.Р. Киселев ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Medical Care ◽  
Median Time ◽  
Myocardial Revascularization ◽  
Care Quality ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Quality Of Medical Care

Введение. Проблема качества оказания медицинской помощи больным с острым коронарным синдромом (ОКС) является одной из наиболее актуальных для нашей страны, так как летальность, особенно при ОКС с подъемом сегмента ST (ОКСсST) остается на высоком уровне. Федеральный регистр больных с ОКС (далее – Регистр) дает возможность выявлять недостатки и разрабатывать подходы к улучшению оказания медицинской помощи больным в реальной клинической практике. Цель исследования: анализ качества оказания медицинской помощи больным с ОКС, прошедших лечение в 2019 году. Материалы и методы. За период с 01.01.2019 по 31.12.2019 в Регистр были внесены данные 27929 больных с ОКС из 138 медицинских организаций 32 субъектов Российской Федерации (средний возраст 65,3±11,7 лет, 62,7% мужчин). Результаты: Из 20757 у 65,9% (n= 13399) диагноз при выписке – острый и повторный инфаркт миокарда, у 32,6% – нестабильная стенокардия. 44,7% (n=9287) составили больные с ОКС с подъемом сегмента ST (ОКСсST), 55,3% (n=11470) – c ОКС без подъема сегмента ST(ОКСбST). Из 9287 больных с ОКСсST75,8% (n=7044) была выполнена реваскуляризация миокарда. Из них у 21,7% (n=1532) использовался фармакоинвазивный подход, у 61,1% (n=4304) больных выполнено только ЧКВ, у 17,0% больных проводили только тромболитичсекую терапию без ЧКВ. Остальным больным реваскуляризация не была проведена и выбрана консервативная тактика лечения. Из 11470 больных с ОКСбST реваскуляризация выполнена лишь у 31,5% (n=3621). У больных с ОКСсSTмедиана времени от момента госпитализации до начала ЧКВ составило 55 [34;106] мин. Медиана времени от начала симптомов заболевания до начала ЧКВ составила 320 [180;807] мин. Среди больных с ОКСбST медиана времени от момента госпитализации до начала ЧКВ составила 195 [75;1025] мин. От начала симптомов заболевания до начала ЧКВ составила 945 [370;2620] мин. Заключение При анализе соответствия клиническим рекомендациям, отмечается, что оказание медицинской помощи больным с ОКС оказывается не в полном объеме, что наиболее выраженно в подгруппе больных с ОКС без подъема сегмента ST. Introduction. The problem of the quality of medical care for patients with acute coronary syndrome (ACS) is one of the most relevant for our country, since mortality, especially for patients with ACS with ST segment elevation (ACSwST) remains high. The Federal Registry of Patients with ACS (hereinafter referred to as the Register) makes it possible to identify gaps in medical care quality and develop approaches for its improvement. Objective: to analyze the quality of medical care for patients with ACS who underwent treatment in 2019. Materials and methods. For the period from January 1, 2019 to December 31, 2019, data from 27029 patients with ACS from 138 medical organizations in 32 regions of the Russian Federation was included in the Registry (average age 65.3 ± 11.7 years, 62.7% of men). Results: Out of 20757, 65.9% (n = 13399) had an acute and repeated myocardial infarction diagnosis at discharge, and 32.6% had unstable angina pectoris. 44.7% (n = 9287) were patients with ACS with ST segment elevation (ACSwST), 55.3% (n = 11470) - with ACS without ST segment elevation (ACSnST). Of 9287 patients with ACSwST, 75.8% (n = 7044) underwent myocardial revascularization. Of these, in 21.7% (n = 1532) the pharmacoinvasive approach was used, in 61.1% (n = 4304) of patients only PCI was performed, in 17.0% of patients only thrombolytic therapy without PCI was performed. The remaining patients did not undergo revascularization and conservative treatment was chosen. Of 11470 patients with ACSnST, revascularization was performed only in 31.5% (n = 3621). In patients with ACSwST, the median time from hospitalization to the onset of PCI was 55 [34; 106] min. The median time from the onset of symptoms to the onset of PCI was 320 [180; 807] min. Among patients with ACSnST, the median time from the time of hospitalization to the onset of PCI was 195 [75; 1025] min. From the onset of symptoms to the onset of PCI, it was 945 [370; 2620] min. Conclusion Analyzing the quality of ACS patients medical care we concluded that ssufficient part of patients with ACS are provided with non-optimal treatment due to clinical guidelines, and the medical care is the it was noted that the provision of medical care to patients with ACS is not in full, which is most pronounced in the subgroup of patients with ACS without raising the ST segment.

scholarly journals Barriers associated with emergency medical service activation in Italian patients with ST-segment elevation acute coronary syndromes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Baldi ◽  
R Camporotondo ◽  
M Gnecchi ◽  
R Totaro ◽  
S Guida ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Signs And Symptoms ◽  
Coronary Intervention ◽  
Prior History ◽  
St Segment Elevation ◽  
Arm Pain ◽  
Coronary Syndrome ◽  
Private Vehicle ◽  
Emergency Medical ◽  
St Segment

Abstract Background Many ST-segment elevation acute coronary syndrome (STEACS) patients fail to activate the Emergency Medical System (EMS), with possible dramatic consequences. Prior studies focusing on barriers to EMS activation include patients with any acute coronary syndrome (ACS) without representation of southern European populations. However, barriers are influenced by the ACS type and by socio-demographic and racial factors. Purpose We aimed to investigate the barriers to EMS call for patients diagnosed for STEACS in Italy. Methods A prospective, single-center, survey-based study, including all the patients treated with primary percutaneous coronary intervention for STEACS in a tertiary hospital in northern Italy from 1st June 2018 to 31st May 2020. Results The questionnaire was filled out by 293 patients. The majority of the participants were males (74%), married (70.4%), with a high-school degree (38.4%) and with a median age of 62 years. Chest pain as a possible symptom related to a cardiovascular attack is known by most of the respondents (89%), and left arm pain/shake by 53.7% of them, whilst the other possible signs and symptoms (i.e. dyspnea, asthenia, sweating, nausea, vomiting, dizziness) were unknown to the majority of the participants. Only 191 (65.2%) of the participants activated the EMS after symptoms onset. The main reasons for not calling EMS were the perception that symptoms were not related to an important health problem (45.5%) and that a private vehicle is faster than EMS to reach the hospital (34.7%). The median time to first medical contact was 60 minutes, and it was significantly higher in the patients who did not called EMS compared to those who did (180 [60–420] mins vs 35 [15–120] mins, p<0.001). The patients who called a private doctor after symptoms onset did not called EMS more frequently than those who did not (5.9% vs 8.2%, p=0.3). Moreover, 30% of the patients who did not call the EMS would still act in the same way if a new episode occurred and the main reasons for this were that they think to be faster than EMS (57.1%) and to live close to the hospital (17.9%). Analyzing predictors of EMS activation, only prior history of cardiovascular disease has been demonstrated to be a predictor of calling the EMS in case of symptoms suspected for STEACS. Conclusions Our study, from the southern Europe, showed that a substantial percentage of patients with symptoms suspected for STEACS preferred private vehicle rather than activating the EMS. Our results highlight the need for information campaigns targeted to both the general population and medical doctors, stressing that the EMS is faster than a private vehicle to direct the patient to the right hospital and increasing the awareness of the people on the type of possible heart attack symptoms, which seem to be the most neglected issues by patients who did not call the EMS. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals DEFECTS OF PROVIDING MEDICAL CARE TO PATIENTS WITH ST SEG-MENT ELEVATION ACUTE CORONARY SYNDROME WHO DID NOT RE-CEIVE REPERFUSION THERAPY

2020 ◽  
Vol 8 (4) ◽  
pp. 531-540
Author(s):  
V.V. Kolosova ◽  
◽  
K.A. Moseichuk ◽  
E.N. Parshikova ◽  
A.A. Pyko ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Medical Care ◽  
Medical Records ◽  
Myocardial Damage ◽  
Medical Personnel ◽  
Reperfusion Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Elevation Acute Coronary Syndrome

Aim. Assess defects in the provision of medical care to patients with ST segment elevation acute coronary syndrome, who did not receive reperfusion therapy. Materials and Methods. The study included patients with acute coronary syndrome with ST segment elevation who did not receive reperfusion therapy being hospitalized to the primary vascular units. The analysis of medical records of hospitalized patients was carried out. Results. The study included 113 patients who satisfied the inclusion criteria, of which 56.6% were men. The average age was 70.3±2.8 years. The most common complaints of patients were chest pain, shortness of breath, weakness, nausea and cold sweat. Most patients had comorbid pathology: arterial hypertension, chronic heart failure, and stable angina pectoris. The reperfusion card was filled out by medical personnel in 47.8% of cases. In 26.5%, the reason for rejection of reperfusion therapy was not clear from the medical records. A loading dose of antiplatelet drugs was used in 76.1% of cases. Anticoagulant parenteral therapy was carried out in 90.2% of cases. During stay in hospital, markers of myocardial damage were determined only in 75.2% of pa-tients. Noteworthy is the low frequency of implementation of echocardiography in the first 24 hours – 12.4%. Despite the high frequency of administrations of the main groups of medical drugs during hospitalization, on discharge from hospital the number of administrations decreased. On discharge, coronary angiography was recommended to only 20.4% of patients. Conclusion. In patients with acute coronary syndrome with ST segment elevation, who did not undergo reperfusion therapy, defects in the provision of medical care were found that could affect the prognosis. The data obtained require further study and should be taken into account in development of educational programs for cardiologists, emergency medical specialists, and anesthesiologists-resuscitationists.

scholarly journals Cardiogenic shock in patients with acute coronary syndrome (data from Russian Federal Acute Coronary Syndrome Registry)

2019 ◽  
Vol 91 (9) ◽  
pp. 47-52
Author(s):  
O V Sagaydak ◽  
E V Oschepkova ◽  
I E Chazova
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiogenic Shock ◽  
Medical Care ◽  
Clinical Guidelines ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Registry System ◽  
St Segment

Mortality in acute coronary syndrome (ACS) and its complications remains high, despite significant advances in the treatment of coronary heart disease and its complications. One of the most life - threatening complications of ACS is cardiogenic shock (CS). CS is an extreme degree of acute heart failure and develops on average in 5-8% of patients hospitalized with ACS. In the present work, we analyzed data from Russian Federal ACS Registry - frequency of CS occurrence, treatment methods, and outcomes of ACS complicated by CS. Aim. Assess the quality of medical care in patients with ACS, which complicated by CS, and its compliance with current clinical guidelines. Materials and methods. Data from patients with ACS were exported from the Russian Federal ACS Registry. The study analyzed the data of 29.736 patients with ACS entered into the registry system in the period from 01.01.2018 to 31.12.2018. Of the 29.736 patients with ACS, 824 patients were diagnosed with CS. To assess the quality of care provided to patients with ACS and CS, the main clinical gguidelines were used. Results. The group of 824 patients with ACS and CS was analyzed. Among them patients with ACS with ST segment elevation prevailed - 77.8% (n=641). According to Russian Federal ACS Registry 44.3% (n=365) of patients with ACS and CS received conservative treatment, of which 58.6% (n=108) were with ACS with ST segment elevation. Percutaneous coronary intervention was performed in 39% (n=321) of patients, of whom 89.4% (n=271) of patients with ACS with ST segment elevation. According to the data of this study, thrombolytic therapy was performed in 26.5% (n=218) of patients. Conclusion. The data obtained demonstrated that patients with ACS and CS did not receive optimal medical care and their treatment does not fully comply with modern clinical guidelines.

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