Direct cost of treatment in patients with acute ST-elevation myocardial infarction in Vietnam

MedPharmRes ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 7-11
Author(s):  
Sy Van Hoang ◽  
Tuan Thanh Tran ◽  
Kha Minh Nguyen
Keyword(s):  
Myocardial Infarction ◽  
Direct Cost ◽  
Treatment Cost ◽  
Financial Burden ◽  
Intervention Group ◽  
St Elevation Myocardial Infarction ◽  
Related Factors ◽  
Female Ratio ◽  
Conservative Group ◽  
St Elevation

Background: Acute myocardial infarction has become a serious financial burden for patients, healthcare system, and society. It is therefore necessary to assess treatment cost of myocardial infarction that had been conducted in many countries in the world and still not fully analysed in Vietnam. Thus, we sought to describe acute ST-elevation myocardial infarction treatment cost and analyse related factors to acute ST-elevation myocardial infarction treatment cost. Methods and Materials: A retrospective cross-sectional study. Patients who was diagnosed by ST-elevation myocardial infarction at Cho Ray Hospital from June 2018 to February 2019, satisfied inclusion and exclusion criteria. Results: We collected 130 patients with acute ST-elevation myocardial infarction with male: female ratio of 3:1, at average age of mean ± Standard deviation (SD) = 62.9 ± 12.6. The length of stay in hospital was mean ± SD = 7.1 ± 3.3 days and the median direct cost of MI was 68,902,500 VND (interquartile range (IQR): 5,737,200 – 104,266,000 VND). The average total cost of acute ST-elevation myocardial infarction in the percutaneous coronary intervention group was more than 16 times as the conservative group. The treatment strategies and hospital complications were major factors that affected treatment cost. Conclusion: The median direct cost of acute ST-elevation myocardial infarction was accounted for 68,902,500 VND. Complications directly affected costs.

scholarly journals A modified chief complaint-based cardiac triage strategy for reducing delays in the management of patients with ST-elevation myocardial infarction

2021 ◽  
Author(s):  
Hung-Yuan Su ◽  
Jen-Long Tsai ◽  
Yin-Chou Hsu ◽  
Kuo-Hsin Lee ◽  
Chao-Sheng Chang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intervention Group ◽  
Chief Complaint ◽  
St Elevation Myocardial Infarction ◽  
Post Intervention ◽  
Tertiary Referral Center ◽  
Before And After ◽  
St Elevation ◽  
Delays In Diagnosis ◽  
Door To Balloon

Abstract Timely performing electrocardiography (ECG) is crucial for early detection of ST-elevation myocardial infarction (STEMI). For shortening door-to-ECG time, a chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside ECG after focused history-taking was implemented at the emergency department (ED) in a single tertiary referral center. All patients diagnosed with STEMI visiting the ED between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of strategy before and after implantation. Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n = 57; post-intervention group, n = 60) showed significant overall improvements in median door-to-ECG time from 5 to 4 minutes (p = 0.02), achievement rate of door-to-ECG time < 10 minutes from 45–57% (p = 0.01), median door-to-balloon time from 81 to 70 minutes (p < 0.01). Significant trends of increase in achievement rates for door-to-ECG and door-to-balloon times (p = 0.01 and p = 0.006, respectively) was noticed after strategy implementation. The incidence of door-to-ECG time > 10 minutes for those with initially underestimated disease severity was also reduced from 90–10% (p < 0.01). In conclusion, a chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.

scholarly journals A Modified Chief Complaint-Based Cardiac Triage Strategy for Reducing Delays in the Management of Patients With ST-Elevation Myocardial Infarction

2020 ◽  
Author(s):  
Hung-Yuan Su ◽  
Jen-Long Tsai ◽  
Yin-Chou Hsu ◽  
Kuo-Hsin Lee ◽  
Chao-Sheng Chang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Intervention Strategy ◽  
Intervention Group ◽  
Strategy Implementation ◽  
Chief Complaint ◽  
St Elevation Myocardial Infarction ◽  
Post Intervention ◽  
Achievement Rate ◽  
St Elevation

Abstract Background: This study aimed at investigating the efficacy of utilizing a modified cardiac triage strategy at the emergency department for timely detection of ST-elevation myocardial infarction (STEMI).Methods: A chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside electrocardiography (ECG) after focused history-taking was implemented at the emergency department of a single tertiary referral center since December 2018. All patients diagnosed with STEMI visiting the emergency department (ED) between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of the strategy by comparing the primary [i.e., door-to-ECG (DTE) time and achievement rate of DTE time<10 minutes] and secondary [i.e., door-to-balloon (DTB) time and achievement rate of DTB time<90 minutes] outcomes among STEMI patients before (pre-intervention) and after (post-intervention) strategy implementation.Results: Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n=57; post-intervention group, n=60) showed significant overall improvements in median DTE time from 5 to 4 minutes (p=0.02), achievement rate of DTE time<10 minutes from 45% to 57% (p=0.01), median DTB time from 81 to 70 minutes (p<0.01). Significant trends were also noted in achievement rates for DTE and DTB times (p=0.01 and p=0.006, respectively) after strategy implementation. The incidence of DTE time>10 minutes for those with initially underestimated disease severity was also reduced from 90% to 10% (p<0.01).Conclusions: A chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.

scholarly journals Determinants of Inpatient Cost for Patients with ST-Elevation Myocardial Infarct at Mayapada Hospital, Tangerang

2020 ◽  
Author(s):  
Willia Gontina S ◽  
◽  
Atik Nurwahyuni ◽  
Keyword(s):  
Myocardial Infarction ◽  
Length Of Stay ◽  
Direct Cost ◽  
St Elevation Myocardial Infarction ◽  
Inpatient Cost ◽  
Inpatient Service ◽  
Payment Method ◽  
Service Cost ◽  
West Java ◽  
St Elevation

ABSTRACT Background: Inpatient health services for heart attack patients is a complex problem and the highest billing rate in hospitals. Due to the high cost of hospitalization, delay treatment cases may cause fatal health consequences. This study aimed to determine factors affecting the inpatient cost for patients with ST-elevation myocardial infarction at Mayapada hos­pital, Tangerang, West Java. Subjects and Method: A cross-sectional study was conducted at Mayapada hospital, Tangerang, West Java, from July to December 2019. A sample of 31 patients diagnosed with ST-elevation myocardial infarction (STEMI) was selected by total sampling. The dependent variable was total inpatient service costs counted according to the clinical pathway. The independent variables were doctor in charge presented the direct cost, age, gender, patient’s distance to hospital, payment method, and length of stay. The data were collected using medical records. The data were analyzed by multiple linear regression. Results: Inpatient service cost in STEMI patients was positively associated with the doctor direct cost (b= 0.51; p= 0.003), distance to hospital (b= 0.13; p= 0.501), and length of stay (b= 0.39; p= 0.330). Inpatient service cost in STEMI patients was negatively associated with age (b= -0.30; p= 0.107), gender (b= -0.13; p= 0.550), and payment method (b= -0.26; p= 0.214). Conclusion: Inpatient service cost in STEMI patients have a positive association with the doctor direct cost, distance to hospital, length of stay, and negative association with age, gender, and payment method. Keywords: inpatient service cost, length of stay, STEMI patients Correspondence: Willia Gontina S. Masters Program in Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, West Java. Email: [email protected]. Mo­bile: +6281280778000. DOI: https://doi.org/10.26911/the7thicph.04.27

P6256Revascularisation for acute coronary syndrome: are we offering elderly patients the correct treatment?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Al-Othman ◽  
Y Zheng ◽  
N Malik
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Intervention Group ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Coronary Syndrome ◽  
St Elevation ◽  
One Year

Abstract Purpose Acute coronary syndrome (ACS) is treated with revascularisation procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Whilst reasonable clinical exclusion criteria exist, age is not one of them and patients of advanced years have been shown to have better outcomes with both treatments than with medical management. We set out to investigate the management and outcomes of patients age seventy five and over, with ACS. Methods A retrospective data analysis of all patients age seventy five and above, prescribed dual antiplatelet therapy (DAPT - aspirin plus clopidogrel or aspirin plus ticagrelor), admitted to our institution over a one year period (April 2015 to April 2016). We analysed electronic records and discharge documents and excluded patients without a diagnosis of ACS. Results 207 patients over 75 years old were treated for ACS; 83.6% (173) were diagnosed with non ST elevation myocardial infarction (NSTEMI), 9.6% (20) diagnosed with ST elevation myocardial infarction (STEMI) and 6.8% (14) diagnosed with unstable angina. 73.4% (152) of patients were managed medically, 14.5% (30) had an angiogram, 11.1% (23) had PCI and 1.0% (2) had CABG. 74.0% (153) of patients were treated with aspirin plus clopidogrel, 26.0% (54) with aspirin plus ticagrelor. Major bleeds were reported in 21 patients (10.1%), 18 of the medically managed patients (8.7%) and 3 in the intervention group (5.5%) (P value 0.30). There were 17 major bleeds in the aspirin and clopidogrel group (11.1%) and 4 in the aspirin and ticagrelor group (7.4%) (P value 0.60). 93 (61.2%) of the medically treated group were alive at one year compared to 47 (85.5%) of the intervention group (P value 0.0008). Conclusion Our data show a clear survival benefit in the intervention group, although comparisons between the groups are challenging given confounding factors, such as co-morbidities and patient preference. However, the high proportion (73.4%) of over 75-years old treated medically warrants further evaluation, given the evidence of benefit for patients in this age group, treated with PCI. We feel there is a need for further research in to the ideas and practice surrounding the management of ACS in the over 75's, and their relation to the available evidence.

scholarly journals Frequency of retinal hemorrhage after thrombolysis with streptokinase in patients presenting with ST-elevation myocardial infarction: A single-center experience at a large tertiary care center in Lahore, Pakistan

2021 ◽  
Vol 15 (2) ◽  
pp. 87-90
Author(s):  
Sarmad Zahoor ◽  
Hafiz Mudabbar Mahboob ◽  
Hafiz Muhammad Sajid Jehangir ◽  
Bilal Mehmood ◽  
Aleena Khan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vision Loss ◽  
Care Center ◽  
Tertiary Care ◽  
Retinal Hemorrhage ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Cross Sectional ◽  
Female Ratio ◽  
St Elevation

Background: Thrombolytic therapy with streptokinase is the mainstay of pharmacological treatment in acute myocardial infarction in Pakistan. Retinal hemorrhage is a common complication of streptokinase-induced thrombolysis and is often overlooked which can lead to permanent vision loss. Therefore, this study was carried out to determine the frequency of retinal hemorrhage after thrombolysis with streptokinase in patients presenting with ST-elevation myocardial infarction (STEMI). Patients and methods: It was an observational, cross-sectional study conducted at the Emergency Department of Mayo Hospital Lahore from 11-08-2015 to 10-02-2016. The patients underwent injection of streptokinase (1.5 million U) intravenously over 60 min and intravenous heparin 5,000 U bolus followed by 1,000 U/hour. Then patients were followed up for 24 hours followed by the ophthalmoscopy to confirm the presence of retinal hemorrhage. The data were entered and analyzed using SPSS version 20. Results: A total of 130 patients were included in this study. The mean age of patients was 62±9.86 years. The male to female ratio was 1.6:1. The retinal hemorrhage was present in 17 (13.08%) patients. About 80 (61.5%) were diabetics and 96 (73.8%) were hypertensive. Stratified variables like age, gender, hypertension, and diabetes were not found associated with retinal hemorrhage (p-value ≥0.05).   Conclusion: Retinal hemorrhage was found in 13.08% after streptokinase injection in patients presenting with STEMI. Although the association was statistically insignificant but still the proportion of retinal hemorrhage was substantially high in these patients. This higher percentage demands vigilant monitoring with the drug for timely diagnosis of this ignored complication which latter can be proved hazardous to the vision.  

scholarly journals A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hung-Yuan Su ◽  
Jen-Long Tsai ◽  
Yin-Chou Hsu ◽  
Kuo-Hsin Lee ◽  
Chao-Sheng Chang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intervention Group ◽  
Chief Complaint ◽  
St Elevation Myocardial Infarction ◽  
Post Intervention ◽  
Tertiary Referral Center ◽  
Before And After ◽  
St Elevation ◽  
Delays In Diagnosis ◽  
Door To Balloon

AbstractTimely performing electrocardiography (ECG) is crucial for early detection of ST-elevation myocardial infarction (STEMI). For shortening door-to-ECG time, a chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside ECG after focused history-taking was implemented at the emergency department (ED) in a single tertiary referral center. All patients diagnosed with STEMI visiting the ED between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of strategy before and after implantation. Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n = 57; post-intervention group, n = 60) showed significant overall improvements in median door-to-ECG time from 5 to 4 min (p = 0.02), achievement rate of door-to-ECG time < 10 min from 45 to 57% (p = 0.01), median door-to-balloon time from 81 to 70 min (p < 0.01). Significant trends of increase in achievement rates for door-to-ECG and door-to-balloon times (p = 0.032 and p = 0.002, respectively) was noted after strategy implementation. The incidences of door-to-ECG time > 10 min for those with initially underestimated disease severity (from 90 to 10%, p < 0.01) and walk-in (from 29.2 to 8.8%, p = 0.04) were both reduced. In conclusion, a chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.

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