Mortality from heart attacks decreased by 20% in the PAUs of Brazil that participate in the “Good Cardiovascular Practices” project, carried out by Hcor and BP – A Beneficência Portuguesa de São Paulo, in partnership with the SUS. The conclusion comes from a study recently published in the journal Telemedicine and e-Health.
The project, carried out through the SUS Institutional Development Support Program (Proadi-SUS), qualifies 900 SUS units, with 24/7 service and provides an electrocardiography device in each department. In the study, data from 300 such units, spread across 26 states, was analyzed, which included information on 13,311 patients treated between January 2021 and December 2023.
According to information from the Ministry of Health, heart attacks are the leading cause of death in the country. It is estimated that 300,000 to 400,000 cases of heart attacks occur each year and that for 5 to 7 cases, death occurs. In urgent and emergency care, timeliness of diagnosis and initiation of treatment is crucial to patient survival and recovery.
— Coronary heart disease is the leading cause of death and although we have made progress in treatment and diagnosis, we have great difficulty in treating it correctly — explains Marcelo Nishyama, cardiologist and medical coordinator of the project, from BP.
In practice, it works like this: the patient arrives at the UPA with chest pain or signs of a cardiovascular problem and undergoes an electrocardiogram. The examination is then sent to the Hcor or BP, where a cardiologist on call exclusively for this service writes the report and returns it within 10 minutes. To give you an idea of the scale of the project, around 7,000 electronic devices are received per day.
— Time is very important for the patient and 10 minutes is the maximum time recommended by all guidelines and consensus — explains Camila Rocon, medical coordinator of Digital Health for assistance and digital health projects at Hcor.
— This period is extremely important not only to reduce mortality, but also morbidity. If treatment is too long or inadequate, the patient may suffer after-effects. But if it is properly cared for and treated as quickly as possible, the risk of after-effects is much lower — adds Marcelo Nishyama, cardiologist and medical coordinator of the project, from BP.
If the report is altered with a severe arrhythmia or a serious heart attack, the doctor contacts the UPA professional where the patient is located and assists him with care.
— We found that it was necessary to guide the UPA doctors because, very often, they did not know how to act when faced with a diagnosis of heart attack or arrhythmia. Teleconsultation provides support to the UPA in cases of more urgent heart attacks and more complex arrhythmias, which can pose a risk to the patient’s life — emphasizes Rocon.
Rocon explains that the project began in 2009, with only remote diagnostics in 2009 to evaluate electrocardiograms. Over time, teleorientation was also added, which made all the difference.
— We realized we needed advice. When diagnosed with a heart attack or arrhythmia, the doctor often didn’t know what to do. We understand that having a teleconsultation where we contact the UPA doctor to provide support in the management of these more serious cases could make a difference in the outcome of this patient — says Rocon.
At the Municipal Emergency Department (SP) of Balneário São José, the interval between the patient’s first contact with hospital care and the electrocardiogram, called “door ECG time”, improved by 52%, and compliance with thrombolytics (essential drugs in the treatment of heart attacks) by 100%; and there was a 3% reduction in time spent between door and needle, thereby optimizing the therapeutic window for patients.
At UPA Engenho Novo (RJ), there was a 70% improvement in door-to-ECG time and a 25% increase in compliance with the use of thrombolytics. According to Carla Santos, nurse coordinator of the Patient Safety Center at UPA Engenho Novo, the time needed to perform the electrocardiogram after the implementation of the program decreased from 21 minutes to 10 minutes.
Compliance with thrombolytics increased from 8% to 61%. And the drug administration time, called “needle door time,” also decreased drastically, from 821 minutes to 135 minutes.
Thrombolytics are a fundamental drug to treat a heart attack, as they reduce the patient’s risk of death by 30%. However, because it is a drug that dissolves clots, there is a risk of bleeding and, according to Rocon, doctors who do not have much experience in this area are afraid to prescribe this treatment. In this context, the support of a cardiologist offers additional security for this decision.
— Today the patient arrives and thanks to the interventions we managed, in a little over two hours, to obtain a result in the care of this patient, with the administration of the thrombolytic in the unit itself, — emphasizes Santos.
Another aspect of the program is the implementation of best practices in selected units to assess opportunities for improvement in time-dependent conditions, such as acute coronary syndrome, stroke and sepsis.
— These are conditions in which, over time, the patient is at greater risk of dying. We therefore help the professional to identify the seriousness of this case and guarantee that the patient receives the best possible treatment within the unit, emphasizes Rocon.
According to Santos, the main difficulty at UPA Engenho Novo was identifying possible cases of sepsis at the right time. Before the program, door-to-doctor time (delay from patient arrival at the unit to care) was 51 minutes. Today it’s 15 minutes.
“Our numbers show that we are saving more lives,” Santos says.
About The Author
