Expert assessment of the suitability of treatment and diagnostic measures in providing emergency care to patients with acute coronary syndrome

Authors

DOI:

https://doi.org/10.15587/2519-4798.2021.232978

Keywords:

acute coronary syndrome, method of expert assessments, medical and diagnostic measures, prehospital stage

Abstract

It is known that it is possible to affect the extent of myocardial damage and, as a result, mortality only in the first hours of its development. Therapeutic tactics in ACS with elevation of the ST segment involves the restoration of coronary blood flow, the main method is the reperfusion of the coronary artery by systemic thrombolysis or PCI in a specialized hospital. The effectiveness of treatment is inversely related to the time spent.

The aim of the study was to examine the opinion of specialists on the feasibility of implementing the items of the protocol of emergency medical care for patients with ACS at the place of call.

Materials and methods. During the study the method of expert evaluations, which consisted of gathering information by interviewing experts and summarizing the individual opinions of experts into a general concept was used. The experts were 48 emergency physicians. The method of expert evaluation included the following stages: development of the questionnaire; survey of experts; summary of examination materials; calculation of statistical indicators; interpretation of the obtained results and formulation of conclusions.

Results. In order to assess the actions of the emergency team, depending on the need to conduct them for diagnosis and emergency care for patients with ACS at the scene, we calculated the feasibility indexes for each item of the protocol. In the future, we divided the treatment and diagnostic measures for ACS with ST segment elevation according to the level of expediency at the scene into four groups (n): n1 – high level, n2 – sufficient level and n3 – low level and n4 – very low level. According to the results of the ranking, the scope of measures to be implemented by the head of the emergency team at the ACS with elevation of the ST segment on arrival on call, as well as measures that, according to interviewed experts, are not required at this stage and can be carried out during transportation of the patient to a specialized hospital.

Conclusions. Based on the results of the calculation of feasibility indices and subsequent ranking of treatment and diagnostic measures for the relevant groups (n1, n2, n3, n4) from 37 items of the study, to assist patients with ACS with ST segment elevation at the scene, it is recommended to perform 16

Author Biographies

Victoria Zabashta, Center of Emergency Care and Disaster Medicine

Director

Bogdan Fedak, Kharkiv Medical Academy of Postgraduate Education

Doctor of Medical Science, Professor

Department of Organization of Health Care, Public Administration

References

  1. Kawecki, D., Morawiec, B., Gąsior, M., Wilczek, K., Nowalany-Kozielska, E., Gierlotka, M. (2019). Annual Trends in Total Ischemic Time and One-Year Fatalities: The Paradox of STEMI Network Performance Assessment. Journal of Clinical Medicine, 8 (1), 78. doi: http://doi.org/10.3390/jcm8010078
  2. Khalid, U., Jneid, H., Denktas, A. E. (2017). The relationship between total ischemic time and mortality in patients with STEMI: every second counts. Cardiovascular Diagnosis and Therapy, 7 (S2), S119–S124. doi: http://doi.org/10.21037/cdt.2017.05.10
  3. Sederholm Lawesson, S., Isaksson, R.-M., Thylén, I., Ericsson, M., Ängerud, K., Swahn, E. (2018). Gender differences in symptom presentation of ST-elevation myocardial infarction – An observational multicenter survey study. International Journal of Cardiology, 264, 7–11. doi: http://doi.org/10.1016/j.ijcard.2018.03.084
  4. Vertkin, A. L., Morozov, S. N., Fedorov, A. I. (2013). Prehospital stage of medical aid to patients with acute coronary syndrome and elevated ST segment. Klinicheskaya meditsina, 7, 65–69.
  5. Kontsevaya, A. V., Kalinina, A. M., Koltunov, I. E., Oganov, R. G. (2011). Sotsialnoekonomicheskiy uscherb ot ostrogo koronarnogo sindroma v Rossiyskoy Federatsii. Ratsionalnaya farmakoterapiya v kardiologii, 7, 158–166.
  6. Dracup, K., McKinley, S., Riegel, B., Moser, D. K., Meischke, H., Doering, L. V. et. al. (2009). A Randomized Clinical Trial to Reduce Patient Prehospital Delay to Treatment in Acute Coronary Syndrome. Circulation: Cardiovascular Quality and Outcomes, 2 (6), 524–532. doi: http://doi.org/10.1161/circoutcomes.109.852608
  7. Veselova, T. N., Merkulova, I. N., Barysheva, N. A., Ternovoy, S. K., Shariya, M. A., Ruda, M. Ya. (2013). Comparison of characteristics of atherosclerotic plaques in patients with acute coronary syndrome and stable ischemic heart disease: data of multispiral computed tomography. Kardiologiya, 53 (12), 14–20.
  8. Nielsen, C. G., Laut, K. G., Jensen, L. O., Ravkilde, J., Terkelsen, C. J., Kristensen, S. D. (2016). Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay. European Heart Journal: Acute Cardiovascular Care, 6 (7), 583–591. doi: http://doi.org/10.1177/2048872616676570
  9. Denktas, A. E., Anderson, H. V., McCarthy, J., Smalling, R. W. (2011). Total Ischemic Time: the correct focus of attention for optimal ST-segment elevation myocardial infarction care. JACC: Cardiovascular Interventions, 4 (6), 599–604. doi: http://doi.org/10.1016/j.jcin.2011.02.012
  10. Foo, C. Y., Bonsu, K. O., Nallamothu, B. K., Reid, C. M., Dhippayom, T., Reidpath, D. D., Chaiyakunapruk, N. (2018). Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis. Heart, 104 (16), 1362–1369. doi: http://doi.org/10.1136/heartjnl-2017-312517
  11. Kim, H. K., Jeong, M. H., Ahn, Y., Chae, S. C., Kim, Y. J., Hur, S. H. et. al. (2017). Relationship between time to treatment and mortality among patients undergoing primary percutaneous coronary intervention according to Korea Acute Myocardial Infarction Registry. Journal of Cardiology, 69 (1), 377–382. doi: http://doi.org/10.1016/j.jjcc.2016.09.002
  12. Shiomi, H., Nakagawa, Y., Morimoto, T., Furukawa, Y., Nakano, A., Shirai, S. et. al. (2012). AS-015: Total Ischemic Time and Primary PCI: Optimal Time Period from Symptom-onset to Reperfusion Therapy. The American Journal of Cardiology, 109 (7), S7. doi: http://doi.org/10.1016/j.amjcard.2012.01.012
  13. Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H. et. al. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European So ciety of Cardiology (ESC). European Heart Journal, 39 (2), 119–177. doi: http://doi.org/10.1093/eurheartj/ehx393
  14. Unifikovanyi klinichnyi protokol ekstrenoi, pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy ta medychnoi reabilitatsii «Hostryi koronarnyi syndrom z elevatsiieiu sehmenta ST» (2014). Nakaz MOZ Ukrainy No. 455. 02.07.2014. Kyiv: Derzhavnyi ekspertnyi tsentr, 7.
  15. Venttsel, E. S., Ovcharov, L. A. (2000). Teoriya veroyatnostey i ee inzhenernye prilozheniya. Moscow: Vysshaya shkola, 480.
  16. Kolkutin, V. V., Pinchuk, P. V., Vasnetsova, O. A. (2005). About selection of experts for the analysis of competitiveness hardware-technical means for carrying out of judicial examinations. Problemy ekspertizy v meditsine, 5 (17), 5–8.
  17. Novosad, V. P., Seliverstov, R. H., Artym, I. I. (2009). Kilkisni metody ekspertnoho otsiniuvannia. Kyiv: NADU, 36.

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Published

2021-05-31

How to Cite

Zabashta, V., & Fedak, B. (2021). Expert assessment of the suitability of treatment and diagnostic measures in providing emergency care to patients with acute coronary syndrome. ScienceRise: Medical Science, (3(42), 38–44. https://doi.org/10.15587/2519-4798.2021.232978

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Section

Medical Science