Early Reperfusion Project for Patients with ST-Segment Elevation Acute Coronary Syndrome in the Public Sector of the Alto Valle of Rio Negro

Science and Policy Interface. A technical offering to policy makers to achieve health results

Abstract

Introduction: In the Alto Valle of Rio Negro (RN) in 2017, a healthcare issue was identified where hospitals do not routinely use thrombolytics (TBL) for immediate treatment of ST-Segment Elevation Acute Coronary Syndrome (STEMI) and instead refer patients for primary percutaneous coronary intervention (PCI).

Objective: To formulate an early reperfusion project that includes pre-hospital/hospital thrombolysis and PCI under the "Code Infarction" (CI) protocol to reduce the years of potential life lost (YPLL) observed in this population and to increase patient capture.

Materials and Methods: The project was formulated using the methodology of socio-sanitary project development from the perspective of macro management.

Results: Prioritizing PCI as the main strategy, STEMI patients from hospitals in the Eastern Health Zone should be referred to Sanatorio Juan XXIII (Level A1) or Clínica Roca (Level A2). Patients from the Western Health Zone should be referred to Fundación Médica (Level A1) or Policlínico Modelo de Cipolletti (Level A2), with direct access to the hemodynamics room.

The arrival times from Catriel and El Cuy are at the threshold for PCI within 120 minutes; therefore, these patients should receive (unless contraindicated) fibrin-specific TBL followed by referral for a pharmaco-invasive strategy.

Conclusions: The situation in the Alto Valle of RN requires immediate, collective, and coordinated actions among different stakeholders to enable network-based treatment of STEMI under the CI protocol, aiming to increase the average life years gained (LYG) and enhance patient capture.