Post-myocardial infarction patient pathways in Portugal
Ricardo Fontes-Carvalho1, Ana Abreu2, Luisa Bento3
1Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Portugal.
Summary
This study analyzed the patient pathway for acute myocardial infarction (AMI) in Portugal, revealing significant variability in care and secondary prevention. Recommendations focus on improving communication and implementing comprehensive rehabilitation programs across all hospital levels.
Area of Science:
- Cardiology
- Public Health
- Healthcare Management
Background:
- Acute myocardial infarction (AMI) impacts 12,000 Portuguese individuals annually.
- Portugal's healthcare system manages AMI through a three-tiered Cardiology Referral Network.
- Understanding the post-hospitalization patient journey is crucial for optimizing care.
Purpose of the Study:
- To characterize the post-hospital treatment pathway for AMI patients across different hospital levels in Portugal.
- To identify areas for improvement in the AMI patient care continuum.
- To propose evidence-based recommendations for enhancing secondary prevention and rehabilitation.
Main Methods:
- A Steering Committee of cardiology experts guided the study methodology.
- A comprehensive literature review of national and international AMI guidelines was conducted.
- Structured interviews with stakeholders across seven hospitals were performed, followed by a consensus meeting.
Main Results:
- Communication and system interconnection varied significantly between urban and inland hospitals.
- Level 3 hospitals demonstrated better information flow and structured cardiac rehabilitation programs.
- Post-discharge follow-up protocols showed high variability, with initial visits often at three months.
Conclusions:
- There is a notable inconsistency in secondary prevention strategies and support for AMI patients across Portuguese hospitals.
- A revised patient pathway is needed, integrating primary care follow-up and specialized programs.
- Implementing structured cardiac rehabilitation programs tailored to hospital levels is essential for improving outcomes.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
32
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
32
01:27Coronary Artery Disease V: Interprofessional Care
39
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
39
01:26Acute Coronary Syndrome V: Nursing Management
46
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
46
01:26Angina IV: Management
32
IntroductionThe management of angina requires a comprehensive approach that includes pharmacological therapies, medical procedures, and lifestyle modifications.Pharmacological TherapiesAntiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, play a pivotal role in preventing thrombus formation in patients with angina. These medications inhibit platelet aggregation and reduce the likelihood of myocardial infarction and other cardiovascular events.Anticoagulants, including...
32
01:20Angina V: Nursing Management
56
Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...
56
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
54
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
54