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Programa en red para la reperfusión del infarto con telemedicina;
Telemedicine Network Program for Reperfusion of Myocardial Infarction

Creators:Silberstein, Alejandro, de Abreu, Maximiliano, Mariani, Javier, Kyle, Diego, González Villamonte, Gabriel, Sarmiento, Ricardo, Tajer, Carlos D.
2015-07-01

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Descripción

Resumen Introducción La atención del infarto en sus primeras horas en el ámbito público requiere una coordinación de los servicios asistenciales integrando programas. Objetivo: evaluar el impacto sobre los tiempos de demora y la tasa de reperfusión de la instrumentación de un programa integral para la reperfusión del infarto en una red hospitalaria pública del conurbano sur bonaerense. Métodos La red está compuesta por seis hospitales de baja-mediana complejidad y un centro de tercer nivel con disponibilidad de hemodinamia las 24 horas. En la  Etapa 1 del programa (2009-2010) se evaluaron las barreras existentes para la reperfusión, en la  Etapa 2 (2011-2013) se incorporaron progresivamente las medidas, y en la  Etapa 3 (2013-2014) se evaluó el programa complementado con becarios en cada hospital. Se midió el impacto del programa en la proporción de pacientes reperfundidos y tiempos a su implementación. Resultados Se internaron un total de 432 pacientes derivados de la red con diagnóstico de infarto con elevación ST. Edad 56 (± 9), hombres 83,3%. La proporción de pacientes reperfundidos aumentó progresivamente: E1 60,7%, E2 69% y E3 78%, p de tendencia=0,01. Los tiempos a la reperfusión se redujeron significativamente entre las E1 y E3, de 120 minutos (IIC 55-240) a 90 minutos (IIC 35-150), p=0,04, con una reducción de mediana de 30 minutos tanto en el tiempo puerta-balón como puerta-aguja. Conclusión La implementación de un programa basado en el diagnóstico de barreras se asoció con un incremento en la proporción de reperfusión del  28,5%, y  con una reducción significativa de los tiempos en la implementación. Este modelo de red para la atención pública basado en algoritmos adaptados a la problemática local puede contribuir a mejorar la asistencia del infarto en nuestro país.

Background: Early management of myocardial infarction in the area of public health requires the integration of specific programsfor the coordination of healthcare services.Objective: The aim of this study was to evaluate the impact on delay times and reperfusion rate of a comprehensive programfor the reperfusion of myocardial infarction in a hospital network of the Southern Greater Buenos Aires.Methods: The network consists of six low-mid-complexity hospitals and a third-level referral center with 24-hour cath-lab.Stage 1 of the program (2009-2010) evaluated the existing barriers to reperfusion; Stage 2 (2011-2013) implemented theprogressive incorporation of improvements and Stage 3 assessed the program (2013-2014) complemented with fellows in eachhospital. Program impact was evaluated by the proportion of patients reperfused and time to its implementation.Results: A total of 432 patients referred from the network were hospitalized with diagnosis of ST-segment elevation myocardialinfarction. Mean age was 56±9 years and 83.3% were men. The proportion of reperfused patients progressively increased:S1 60.7%, S2 69% and S3 78%, p for trend=0.01. Time to reperfusion decreased significantly between S1 and S3, from 120minutes (IQR 55-240) to 90 minutes (IQR 35-150), p=0.04, with a median reduction of 30 minutes in the door-to-balloon anddoor-to-needle times.Conclusions: The application of a program for myocardial reperfusion based on the diagnosis of barriers was associated with28.5% increase in reperfusion, and a significant reduction in the implementation times. This public network model built onalgorithms adapted to local barriers may contribute to improve the care of myocardial infarction in our country.

Metadatos destacados

Colecciones
Argentine Journal of Cardiology

Editor

Sociedad Argentina de Cardiología

Fuente

Revista Argentina de Cardiología; Vol 83, No 3 (2015); 187-193, Argentine Journal of Cardiology; Vol 83, No 3 (2015); 187-193

Citación

Silberstein, Alejandro et al., “Programa en red para la reperfusión del infarto con telemedicina,” Archivo PPCT, consulta 2 de abril de 2026, http://archivoppct.caicyt.gov.ar/items/show/8867.

Dublin Core

Materia

Autor

Silberstein, Alejandro
de Abreu, Maximiliano
Mariani, Javier
Kyle, Diego
González Villamonte, Gabriel
Sarmiento, Ricardo
Tajer, Carlos D.

Fuente

Revista Argentina de Cardiología; Vol 83, No 3 (2015); 187-193
Argentine Journal of Cardiology; Vol 83, No 3 (2015); 187-193

Editor

Sociedad Argentina de Cardiología

Fecha

2015-07-01

Derechos

Los que firman al pié, certificamos que tenemos total responsabilidad por la conducción de este estudio y por el diseño y la interpretación de los datos. Nosotros escribimos el manuscrito y somos responsables por la decisión acerca del mismo. Cada uno de nosotros cumple la definición de autor como se afirma en el Comité Internacional de Editores de Revistas Médicas (International Committee of Medical Journal Editors, ver www.icmje.org). Nosotros hemos visto y aprobado el manuscrito final. Ni el artículo, ni ninguna parte esencial del mismo, incluido las tablas y las figuras, será publicado o admitido para arbitrar a otra parte antes de aparecer en la Revista.También notificamos haber leído la sección “conflicto de intereses”, y revelaríamos cualquiera que existiera. Dejamos constancia que si nuestro artículo se publicara en la RAC, cederíamos los derechos (copyright) a la Revista.Los documentos publicados en esta revista están bajo la licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.
Those signing below certify that we have full responsibility for the conduction of this study and for the design and interpretation of the information. We wrote the manuscript and are responsible for its decision. Each of us fulfills the definition of authorship as stated by the International Committee of Medical Journal Editors ( www.icmje.org). We have signed and approved the final manuscript. Neither the manuscript, nor any essential part thereof, including tables and figures, will be published or accepted for refereeing elsewhere before being published in the Journal. We have also read the "Conflict of Interest" section and would disclose any existing. We state that if our manuscript is published in the RAC, we shall transfer the copyright to the Journal.

Formato

Idioma

spa
eng

Tipo

info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion