Training Non-Cardiologists Could Improve the Treatment Results of ST Elevation Myocardial Infarction
Luiz Antonio Machado Cesar1, Antonio Padua Mansur1, Rui Fernando Ramos2
1InCor - Instituto do Coração do Hospital das Clínicas da FMUSP, São Paulo, SP - Brasil.
Insights
Simple training for emergency staff significantly reduces heart attack deaths in developing nations. This program improved survival rates for ST elevation myocardial infarction (STEMI) patients in São Paulo.
Area of Science:
- Cardiology
- Public Health
- Medical Education
Background:
- Acute myocardial infarction (AMI) poses a significant mortality risk in emerging economies, particularly in Brazil.
- Mortality from ST elevation myocardial infarction (STEMI) is a primary concern in Brazil.
- Non-cardiologists in emergency settings in São Paulo lacked specialized training for AMI management.
Purpose of the Study:
- To decrease in-hospital mortality rates associated with acute myocardial infarction.
- To implement and evaluate a training program for emergency medical personnel in São Paulo.
Main Methods:
- A training program involving internet modules, symposia, and educational materials was developed.
- The program targeted personnel in five high-admission STEMI hospitals.
- Statistical analysis utilized the two-proportion comparison test (p <0.05).
Main Results:
- Nearly 200 physicians and 350 nurses participated in the training between May 2010 and December 2013.
- Initial challenges included emergency physicians' ability to recognize AMI on ECG; tele-electrocardiography adoption was noted.
- In-hospital STEMI mortality decreased from 25.6% (2009) to 18.2% (2010) in participating hospitals (p=0.005).
- Overall STEMI mortality in São Paulo public hospitals dropped from 14.31% (2009) to 11.25% (2014) (p<0.0001).
Conclusions:
- Basic training programs for emergency personnel can substantially lower AMI death rates in developing countries.
- The intervention demonstrated a significant reduction in STEMI-associated mortality in São Paulo.
Background:
According to the World Health Organization, emerging countries will have an enormous growth in the number of heart attacks and related deaths. The main medical issue in Brazil is mortality caused by acute ST elevation myocardial infarction (STEMI). The Society of Cardiology in the State of São Paulo has never trained non-cardiologists as emergency personnel. Patients usually seek help from emergency departments instead of calling for an ambulance.
Objectives:
We aimed at reducing in-hospital death rates from acute myocardial infarction by training emergency personnel in the city of Sao Paulo.
Methods:
We used a training program for the personnel of five hospitals with >100 patients admitted with STEMI per year, and at least 15% in-hospital STEMI-associated mortality rate. We performed internet training, biannual-quarterly symposia for up to 400 participants, informative folders and handouts. Statistical analysis used the two proportion comparison test with p <0.05.
Results:
Nearly 200 physicians and 350 nurses attended at least one training from May 2010 to December 2013. Initially, many emergency physicians could not recognize an acute myocardial infarction on the electrocardiogram, but tele-electrocardiography is used in some emergency departments to determine the diagnosis. The death rate in the five hospitals decreased from 25.6%, in 2009, to 18.2%, in 2010 (p=0.005). After the entire period of training, the STEMI-associated death rate in all public hospitals of São Paulo decreased from 14.31%, in 2009, to 11.25%, in 2014 (p<0.0001).
Conclusion:
Even simple training programs for emergency personnel can greatly reduce acute myocardial infarction death rates in undeveloped countries.
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