scholarly journals REGIONAL CARDIAC NETWORK: THE EXPERIENCE AT THE EMERGENCY MEDICAL SERVICE 118 IN THE BASILICATA REGION IN ITALY

2015 ◽  
Vol 3 (5) ◽  
pp. 95-110
Author(s):  
Antonietta Zaccaro ◽  
Antonio Bonacaro
Keyword(s):  
Myocardial Infarction ◽  
Emergency Medical Service ◽  
Acute Coronary Syndromes ◽  
Medical Service ◽  
Clinical Practices ◽  
Basilicata Region ◽  
Emergency Medical ◽  
Coronary Syndromes ◽  
St Elevation ◽  
The Impact

The aim of the regional cardiac networks is to offer to those patients affected by Acute Myocardial Infarction (AMI) the quickest and the most efficient treatment in relation to patients' characteristics and to the place where the event occurs. This article describes the experience developed by the Regional Emergency Medical Service of the Basilicata Region (Italy) in creating such a network. The structure of the network, the epidemiological data along with the different types of pathway used in the management of Non-ST elevation acute coronary syndromes are delineated with the aim to offer an overview of the clinical practices actually in place. A retrospective observational study was conducted in 2012 with the aim to understand the incidence of AMI in its various forms: ST segment elevation myocardial infarction (STEMI) and Non-ST elevation acute coronary syndromes (NSTEACS). The development of the Regional Cardiac Network has been shedding light on AMI and giving patients the chance to receive a customized treatment according to their clinical conditions. Further studies are recommended in order to understand the impact of these practices in terms of reduction of mortality and complications.

scholarly journals Emergency medical service evaluations for chest pain during the COVID-19 lockdown in Hollands-Midden, the Netherlands

2020 ◽  
Author(s):  
Enrico de Koning ◽  
Mark Boogers ◽  
Jan Bosch ◽  
Matthijs de Visser ◽  
Martin Schalij ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Relative Risk Reduction ◽  
Cardiac Symptoms ◽  
Emergency Medical ◽  
St Elevation ◽  
Pain Patients ◽  
Hospital Cardiac Arrest

Abstract Objective: To assess whether the COVID-19 lockdown might have had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods: All emergency medical service (EMS) rides for chest pain and out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served >800.000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and compared to the same period in 2019 in two cohorts. The primary end-point was the incidence of evaluated chest pain patients during the COVID-19 lockdown. In addition, the incidence of EMS evaluations of ST elevation myocardial infarction (STEMI) and OHCA were assessed.Results: During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, 62±17 years) as compared to 1041 patients (51% male, 63±17 years) in the same period in 2019 corresponding with a significant relative risk reduction of 0.88 (95% CI 0.81-0.96; P=0.006). Similarly, there was a significant reduction in the incidence of STEMI patients (RR 0.52; P=0.009) whereas the incidence of OHCA (RR 1.23; P=0.29) remained unchanged. Conclusion: During the COVID-19 lockdown, there was a significant decrease in patients with chest pain evaluated by the EMS paralleled by a reduction in STEMIs, while the incidence of OHCA remained similar. While the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be drawn to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

scholarly journals 342 Impact of temporary traffic bans on the risk of acute coronary syndromes in a large metropolitan area

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N81-N82
Author(s):  
Alessandra De Luca ◽  
Igino Proietti ◽  
Carlo Trani ◽  
Andrea Berni ◽  
Sonia Cristina Sergi ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Myocardial Infarction ◽  
Metropolitan Area ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Large Metropolitan Area ◽  
Coronary Syndromes ◽  
St Elevation ◽  
The Impact

Abstract Aims Strong epidemiologic evidence has highlighted the role of pollution, on top of adverse climate features, as a novel cardiovascular risk factor. However, mechanistic proof that reducing pollution may be beneficial to prevent atherothrombotic events is limited. We aimed at appraising the impact of temporary traffic bans in a large metropolitan area on the risk of acute coronary syndromes. Methods and results Aggregate and anonymized data from 15 tertiary cardiac care centers were obtained detailing pre-coronarivus disease 2019 (COVID-19) daily cases of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), including those treated with percutaneous coronary intervention (PCI). Data on pollutants and climate were sought for the same days. Mixed level regression was used to compare the week before vs. after the traffic ban (Fortnight analysis), the 3 days before vs. after (Weekly analysis) and the Sunday before vs. after (Sunday analysis). A total of 8 days of temporary traffic bans were included, occurring between 2017 and 2020, totaling 802 STEMI and 1196 NSTEMI in the Fortnight analysis, 382 STEMI and 585 in the Weekly analysis, and 148 STEMI and 210 NSTEMI in the Sunday analysis. Fortnight and Sunday analysis did not disclose a significant impact of traffic ban on STEMI or NSTEMI (all P > 0.05). Conversely, Weekly analysis showed non-significant changes for STEMI but a significant decrease in daily NSTEMI when comparing the 3 days before the traffic ban with the ban day (P = 0.043), as well as the 3 days before vs. the 3 days after the ban (P = 0.025). No statistically significant effect of traffic ban was found at Fortnight, Weekly or Sunday analyses for daily mean concentrations of benzene, carbon monoxide, nitric oxide, nitrogen dioxide, ozone, sulfur dioxide, particulate matter (PM) <2.5 µm or PM < 10 µm (all P > 0.05). However, minimum daily concentrations showed a significant reduction of ozone during the ban in comparison to the week preceding it (P = 0.034), nitric oxide during the ban in comparison to the 3 days preceding it (P = 0.046), and an increase in benzene during the ban in comparison to the Sunday before (P = 0.039). Conclusion Temporary traffic bans may favorably reduce coronary atherothrombotic events, and in particular NSTEMI, even if not globally and immediately impacting on environmental pollution. Further controlled studies are required to confirm and expand this hypothesis-generating results.

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