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How has the management of acute coronary syndrome changed in the Russian Federation during the last 10 years?

ABSTRACT: We report trends and patterns of percutaneous cardiovascular interventions (PCI) by region for 2005-2009, with more detailed data on management of myocardial infarctions in 2009-2103, relating them to regional economic development and changes in mortality from myocardial infarction.PCIs per 100,000 population increased from 8.7 in 2005-71.3 in 2013, with considerable regional variation. In 2013 the highest rates were in the wealthiest regions, although not in some remote regions dependent on oil and mineral extraction. Between 2009 and 2013 rates of thrombolysis in those with acute myocardial infarctions potentially eligible for treatment remained broadly similar at about 28% but rates of primary revascularisation with stenting rose rapidly, from 6.5% to 23.7%. In-hospital mortality from myocardial infarction since 2009 has declined most in regions achieving highest rates of primary revascularisation.The sustained investment in advanced cardiovascular technology has been associated with substantial increases in revascularisation in some but not all regions. However, rates overall remain far behind those in Western Europe. Further research is in progress to understand the reasons for these variations and the barriers to further expansion of services.

SUBMITTER: Kontsevaya A

PROVIDER: S-EPMC5710997 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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How has the management of acute coronary syndrome changed in the Russian Federation during the last 10 years?

Kontsevaya Anna A Sabgaida Tamara T Ivanova Alla A Leon David A DA McKee Martin M

Health policy (Amsterdam, Netherlands) 20171005 12

<h4>Methods</h4>We report trends and patterns of percutaneous cardiovascular interventions (PCI) by region for 2005-2009, with more detailed data on management of myocardial infarctions in 2009-2103, relating them to regional economic development and changes in mortality from myocardial infarction.<h4>Results</h4>PCIs per 100,000 population increased from 8.7 in 2005-71.3 in 2013, with considerable regional variation. In 2013 the highest rates were in the wealthiest regions, although not in some ...[more]

PMID: 29029811

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Project description:IntroductionAlthough stroke patients in Slovakia had been treated according to European recommendations, no network of primary and comprehensive stroke centers had been officially established; the ESO recommended quality parameters had not been fulfilled. Therefore, the Slovak Stroke Society decided to change the stroke management concept and introduced mandatory evaluation of quality parameters. This article focuses on key success factors of the change in stroke management in Slovakia and presents the 5-year results and perspectives for the future.Material and methodsWe processed data from the stroke register at the National Health Information Center, which is mandatory in Slovakia for all hospitals designated as primary and secondary stroke care centers.ResultsSince 2016, we have started to change stroke management. New National Guideline for Stroke Care was prepared in 2017 and published in 2018 as a Recommendation of the Ministry of Health of the Slovak Republic. The recommendation included pre-hospital as well as in-hospital stroke care, a network of primary stroke centers (hospitals administering intravenous thrombolysis - 37), and secondary stroke centers (hospitals treating with intravenous thrombolysis + endovascular treatment (ET) - 6). A stroke priority was instituted, having equally high priority as myocardial infarction. More efficient in-hospital workflow and pre-hospital patient triage shortened the time to treatment. Prenotification became mandatory in all hospitals. Non-contrast CT, and CT angiography is mandatory in all hospitals. In patients with suspected proximal large-vessel occlusion the EMS stays at the CT facility in primary stroke centers until the CT angiography is finished. If LVO is confirmed, the patient is transported to an EVT secondary stroke center by the same EMS. From 2019 all secondary stroke centers offer endovascular thrombectomy in a 24/7/365 system. We consider the introduction of quality control one of the most critical steps in stroke management. The result of these activities is 25.2% of patients treated with IVT and 10.2% by endovascular treatment, and median DNT 30 min. Number of patients screened for dysphagia increased from 26.4% in 2019 to 85.9% in 2020. In the most of the hospitals the proportion of ischemic stroke patients discharged with antiplatelets and in case of AF with anticoagulants was >85%.DiscussionOur results indicate that it is possible to change stroke management at a single hospital and national level. For continuous and further improvement, regular quality monitoring is necessary; therefore, the results of stroke hospital management are presented regularly once a year at national and international level. Collaboration with the "Second for Life" patient organization is very important for the "time is brain" campaign in Slovakia.ConclusionDue to the change in stroke management over the last 5 years, we have reduced the time for acute stroke treatment and improved the proportion of patients with acute treatment, and in this area, we have achieved and exceeded the goals of the Stroke Action Plan for Europe for 2018-2030. Nevertheless, we still have many insufficiencies in stroke rehabilitation and post-stroke nursing that need to be addressed.

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How has the management of acute coronary syndrome changed in the Russian Federation during the last 10 years?

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How has the management of acute coronary syndrome changed in the Russian Federation during the last 10 years?

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