Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges
Objectives: To study the impact of a ‘hub and spoke’ STEMI management programme on delivery of thrombolysis in the state of Goa. Methods: A prospective observational study was conducted to assess the ‘hub and spoke’ model STEMI programme in the state of Goa. Data was collected using predesigned prof...
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| Format: | Article |
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Elsevier
2025-03-01
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| Series: | Indian Heart Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0019483225000136 |
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| author | Guruprasad Naik Amar Prabhudesai Venkatesh Malali Michelle Viegas Parab Joel Quadros Pankajam Vaidya Edward D'Mello Swapnil Arsekar Radha Valaulikar |
| author_facet | Guruprasad Naik Amar Prabhudesai Venkatesh Malali Michelle Viegas Parab Joel Quadros Pankajam Vaidya Edward D'Mello Swapnil Arsekar Radha Valaulikar |
| author_sort | Guruprasad Naik |
| collection | DOAJ |
| description | Objectives: To study the impact of a ‘hub and spoke’ STEMI management programme on delivery of thrombolysis in the state of Goa. Methods: A prospective observational study was conducted to assess the ‘hub and spoke’ model STEMI programme in the state of Goa. Data was collected using predesigned proformas filled at Primary Health Centres or District Hospitals which served as the spokes. Primary programme efficacy outcomes studied were the proportion of eligible patients of STEMI receiving thrombolysis and the time to thrombolysis. Secondary outcome assessed was in-hospital mortality. Results: A total of 2050 number of patients were diagnosed with STEMI between November 2019 and March 2022, of which complete data was available for 1325 patients. After ruling out contraindications, delayed presentations or refusal for treatment, 74.3 % of STEMI patients received thrombolysis. The median window period was 130.83 min with an interquartile range (IQR) of 159.63 min. The median time from presentation to recording ECG was 7.9 (IQR = 11.63) minutes and presentation to cloud diagnosis was 11.78 (IQR = 12.96) minutes. The median time from presentation to administering thrombolysis (Door to Needle time) was 18.48 (IQR = 28.85) minutes. Only 0.22 % patients received inappropriate thrombolysis and the in-hospital mortality was 9.4 %. Conclusion: A STEMI programme utilizing the existing manpower and primary health care setup improved ‘secondary’ level of care to patients by providing thrombolysis to a high percentage of patients in quick time. This may serve as a model to improve the outreach of reperfusion therapy in a resource challenged country like India. |
| format | Article |
| id | doaj-art-c007ba030a8d4c8499e5dce0f6013ff0 |
| institution | Kabale University |
| issn | 0019-4832 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Indian Heart Journal |
| spelling | doaj-art-c007ba030a8d4c8499e5dce0f6013ff02025-08-20T03:47:31ZengElsevierIndian Heart Journal0019-48322025-03-01772677210.1016/j.ihj.2025.02.004Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challengesGuruprasad Naik0Amar Prabhudesai1Venkatesh Malali2Michelle Viegas Parab3Joel Quadros4Pankajam Vaidya5Edward D'Mello6Swapnil Arsekar7Radha Valaulikar8Department of Cardiology, Goa Medical College, Bambolim, Goa, 403202, IndiaDepartment of Cardiology, Goa Medical College, Bambolim, Goa, 403202, India; Corresponding author. Flat No. 302, Building No. 8, Mathias Ocean Park Residency, Dona Paula, Panaji, Goa, 403004, India.Department of Cardiology, Goa Medical College, Bambolim, Goa, 403202, IndiaDepartment of Cardiology, Goa Medical College, Bambolim, Goa, 403202, IndiaDepartment of Cardiology, Goa Medical College, Bambolim, Goa, 403202, IndiaDepartment of Cardiology, Goa Medical College, Bambolim, Goa, 403202, IndiaSouth Goa District Hospital, Margao, Goa, IndiaNorth Goa District Hospital, Mapusa, Goa, IndiaNational Program for NCDs, National Health Mission-Goa, IndiaObjectives: To study the impact of a ‘hub and spoke’ STEMI management programme on delivery of thrombolysis in the state of Goa. Methods: A prospective observational study was conducted to assess the ‘hub and spoke’ model STEMI programme in the state of Goa. Data was collected using predesigned proformas filled at Primary Health Centres or District Hospitals which served as the spokes. Primary programme efficacy outcomes studied were the proportion of eligible patients of STEMI receiving thrombolysis and the time to thrombolysis. Secondary outcome assessed was in-hospital mortality. Results: A total of 2050 number of patients were diagnosed with STEMI between November 2019 and March 2022, of which complete data was available for 1325 patients. After ruling out contraindications, delayed presentations or refusal for treatment, 74.3 % of STEMI patients received thrombolysis. The median window period was 130.83 min with an interquartile range (IQR) of 159.63 min. The median time from presentation to recording ECG was 7.9 (IQR = 11.63) minutes and presentation to cloud diagnosis was 11.78 (IQR = 12.96) minutes. The median time from presentation to administering thrombolysis (Door to Needle time) was 18.48 (IQR = 28.85) minutes. Only 0.22 % patients received inappropriate thrombolysis and the in-hospital mortality was 9.4 %. Conclusion: A STEMI programme utilizing the existing manpower and primary health care setup improved ‘secondary’ level of care to patients by providing thrombolysis to a high percentage of patients in quick time. This may serve as a model to improve the outreach of reperfusion therapy in a resource challenged country like India.http://www.sciencedirect.com/science/article/pii/S0019483225000136ST elevation myocardial infarction (STEMI)ThrombolysisHub and spokeCloud ECG |
| spellingShingle | Guruprasad Naik Amar Prabhudesai Venkatesh Malali Michelle Viegas Parab Joel Quadros Pankajam Vaidya Edward D'Mello Swapnil Arsekar Radha Valaulikar Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges Indian Heart Journal ST elevation myocardial infarction (STEMI) Thrombolysis Hub and spoke Cloud ECG |
| title | Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges |
| title_full | Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges |
| title_fullStr | Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges |
| title_full_unstemmed | Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges |
| title_short | Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges |
| title_sort | implementation of a hub and spoke stemi goa project initial results gains and challenges |
| topic | ST elevation myocardial infarction (STEMI) Thrombolysis Hub and spoke Cloud ECG |
| url | http://www.sciencedirect.com/science/article/pii/S0019483225000136 |
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