Aims: In Brazil, there are considerable disparities in access to healthcare. The aim of this study was to assess how implementation of a coordinated regional management protocol for patients with ST-elevation myocardial infarction (STEMI) affected quality of care and outcomes in a rural and deprived Brazilian region with considerable social inequalities.
Methods and results: The quality of care and outcomes of STEMI was evaluated in two cohorts before (n = 214) and after (n = 143) implementation of the coordinated regional management protocol. Central to this protocol was a tablet-based digital electrocardiogram (ECG) recording in the emergency ambulance that was transmitted for analysis by trained professionals. If the pre-hospital ECG was diagnostic, it triggered a management cascade involving a direct transfer to the regional intervention centre with reperfusion by primary percutaneous coronary intervention (PPCI) or pre-hospital fibrinolysis for anticipated journey times of less than or greater than 2 h, respectively. Following implementation of the protocol, the adjusted medical delay (system delay 2 transport time) decreased by 40% (95% confidence intervals: 266%, 213%). The proportion of patients who received reperfusion therapy increased from 70.6 to 80.8% (P = 0.045), with increases in treatment with aspirin [94.2-100% (P = 0.003)] and P2Y12 inhibitors [87.5-100% (P < 0.001)]. The odds of in-hospital death showed a non-significant decrease [odds ratio 0.73 (95% confidence intervals: 0.34-1.60)].
Conclusion: The implementation of a coordinated regional management protocol for patients with STEMI led to marked improvements in the quality of care in a remote Brazilian region with limited resources.

Additional Metadata
Keywords Hospital mortality, Myocardial infarction, Practice guidelines, Quality assurance/health care, Telemedicine
Persistent URL dx.doi.org/10.1093/ehjqcco/qcw020, hdl.handle.net/1765/106210
Journal European Heart Journal - Quality of Care and Clinical Outcomes
Citation
Marino, B.C.A. (Bárbara Campos Abreu), Ribeiro, A.L, Alkmim, M.B.M, Antunes, A.P. (Andre Pires), Boersma, H, & Marcolino, M.S. (2016). Coordinated regional care of myocardial infarction in a rural area in Brazil. European Heart Journal - Quality of Care and Clinical Outcomes, 2(3), 215–224. doi:10.1093/ehjqcco/qcw020