A nurse-led pre-hospital triage service for identifying patients with occlusive myocardial infarction: a service evaluation: a service evaluation

Charles Knoery; Charlie  Bloe; Aleeha Iftikhar; RR Bond; Matthew Manktelow; V. E. McGilligan; Khaled Rjoob; Aaron Peace; Anne McShane; Janet Heaton; Stephen James Leslie

doi:10.12968/bjca.2021.0082

A nurse-led pre-hospital triage service for identifying patients with occlusive myocardial infarction: a service evaluation: a service evaluation

Charles Knoery, Charlie Bloe, Aleeha Iftikhar, RR Bond, Matthew Manktelow, V. E. McGilligan, Khaled Rjoob, Aaron Peace, Anne McShane, Janet Heaton, Stephen James Leslie

Research output: Contribution to journal › Article › peer-review

83 Downloads (Pure)

Abstract

Background/Aims Acute coronary syndromes include unstable angina and myocardial infarction, of which occlusive myocardial infarction is a high-risk subset that is often missed because of a lack of ST elevation. Pre-hospital electrocardiograms may be able to identify myocardial infarction early and reduce mortality. However, it is unclear whether pre-hospital electrocardiograms can accurately detect occlusive myocardial infarction and how this affects outcomes. This study will analyse the outcomes of patients with occlusive myocardial infarction who had a pre-hospital electrocardiogram. Method Electrocardiograms transmitted to the coronary care unit triage service were identified, along with data regarding patient demographics, referrals and mortality. Data were analysed for correlations between demographic and clinical factors and type of myocardial infarction. Results A total of 838 electrocardiograms were identified; 69 (8.2%) showed myocardial infarction and eight (1.0%) showed occlusive myocardial infarction, of which 50% had ST elevation. Patients with occlusive myocardial infarction were more likely to be triaged to the coronary care unit than patients with non-occlusive myocardial infarction (P=0.04). However, 38 (55.1%) of the patients with myocardial infarction and four (50.0%) of the patients with occlusive myocardial infarction were not directed to a coronary care unit or the catheterisation laboratory. Patients with occlusive myocardial infarction had higher index episode mortality rates (P=0.03) and 30-day mortality rates (P<0.01). Conclusions Despite pre-hospital electrocardiogram transmission and adherence to the guidelines, triage of myocardial infarction and occlusive myocardial infarction is imperfect. Refinement of risk scores and adaptation of new technology is required to help identify patients with occlusive myocardial infarction so they can be prioritised for immediate reperfusion therapy.

Original language	English
Pages (from-to)	1-10
Number of pages	10
Journal	British Journal of Cardiac Nursing
Volume	17
Issue number	4
Early online date	2 Apr 2022
DOIs	https://doi.org/10.12968/bjca.2021.0082
Publication status	Published (in print/issue) - 26 Apr 2022

Bibliographical note

This project was supported by the European Union’s INTERREG VA Programme, managed by the
Special EU Programmes Body. The funders of this project had no input in the design,
implementation or writing of this study.

Keywords

acute myocardial infarction
occlusive myocardial infarction
STEMI
ECG

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.12968/bjca.2021.0082

Charles Knoery BJCN Final (non-tracked)Author Accepted Manuscript, 260 KB

Cite this

Knoery, C., Bloe, C., Iftikhar, A., Bond, RR., Manktelow, M., McGilligan, V. E., Rjoob, K., Peace, A., McShane, A., Heaton, J., & Leslie, S. J. (2022). A nurse-led pre-hospital triage service for identifying patients with occlusive myocardial infarction: a service evaluation: a service evaluation. British Journal of Cardiac Nursing, 17(4), 1-10. https://doi.org/10.12968/bjca.2021.0082

@article{233d247feab84de0adbf26dea07c2a2f,

title = "A nurse-led pre-hospital triage service for identifying patients with occlusive myocardial infarction: a service evaluation: a service evaluation",

abstract = "Background/Aims Acute coronary syndromes include unstable angina and myocardial infarction, of which occlusive myocardial infarction is a high-risk subset that is often missed because of a lack of ST elevation. Pre-hospital electrocardiograms may be able to identify myocardial infarction early and reduce mortality. However, it is unclear whether pre-hospital electrocardiograms can accurately detect occlusive myocardial infarction and how this affects outcomes. This study will analyse the outcomes of patients with occlusive myocardial infarction who had a pre-hospital electrocardiogram. Method Electrocardiograms transmitted to the coronary care unit triage service were identified, along with data regarding patient demographics, referrals and mortality. Data were analysed for correlations between demographic and clinical factors and type of myocardial infarction. Results A total of 838 electrocardiograms were identified; 69 (8.2%) showed myocardial infarction and eight (1.0%) showed occlusive myocardial infarction, of which 50% had ST elevation. Patients with occlusive myocardial infarction were more likely to be triaged to the coronary care unit than patients with non-occlusive myocardial infarction (P=0.04). However, 38 (55.1%) of the patients with myocardial infarction and four (50.0%) of the patients with occlusive myocardial infarction were not directed to a coronary care unit or the catheterisation laboratory. Patients with occlusive myocardial infarction had higher index episode mortality rates (P=0.03) and 30-day mortality rates (P<0.01). Conclusions Despite pre-hospital electrocardiogram transmission and adherence to the guidelines, triage of myocardial infarction and occlusive myocardial infarction is imperfect. Refinement of risk scores and adaptation of new technology is required to help identify patients with occlusive myocardial infarction so they can be prioritised for immediate reperfusion therapy.",

keywords = "acute myocardial infarction, occlusive myocardial infarction, STEMI, ECG",

author = "Charles Knoery and Charlie Bloe and Aleeha Iftikhar and RR Bond and Matthew Manktelow and McGilligan, {V. E.} and Khaled Rjoob and Aaron Peace and Anne McShane and Janet Heaton and Leslie, {Stephen James}",

note = "This project was supported by the European Union{\textquoteright}s INTERREG VA Programme, managed by the Special EU Programmes Body. The funders of this project had no input in the design, implementation or writing of this study. ",

year = "2022",

month = apr,

day = "26",

doi = "10.12968/bjca.2021.0082",

language = "English",

volume = "17",

pages = "1--10",

journal = "British Journal of Cardiac Nursing",

issn = "1749-6403",

publisher = "Mark Allen Group",

number = "4",

}

Knoery, C, Bloe, C, Iftikhar, A, Bond, RR , Manktelow, M , McGilligan, VE, Rjoob, K, Peace, A, McShane, A, Heaton, J & Leslie, SJ 2022, 'A nurse-led pre-hospital triage service for identifying patients with occlusive myocardial infarction: a service evaluation: a service evaluation', British Journal of Cardiac Nursing, vol. 17, no. 4, pp. 1-10. https://doi.org/10.12968/bjca.2021.0082

TY - JOUR

T1 - A nurse-led pre-hospital triage service for identifying patients with occlusive myocardial infarction: a service evaluation

T2 - a service evaluation

AU - Knoery, Charles

AU - Bloe, Charlie

AU - Iftikhar, Aleeha

AU - Bond, RR

AU - Manktelow, Matthew

AU - McGilligan, V. E.

AU - Rjoob, Khaled

AU - Peace, Aaron

AU - McShane, Anne

AU - Heaton, Janet

AU - Leslie, Stephen James

N1 - This project was supported by the European Union’s INTERREG VA Programme, managed by the Special EU Programmes Body. The funders of this project had no input in the design, implementation or writing of this study.

PY - 2022/4/26

Y1 - 2022/4/26

N2 - Background/Aims Acute coronary syndromes include unstable angina and myocardial infarction, of which occlusive myocardial infarction is a high-risk subset that is often missed because of a lack of ST elevation. Pre-hospital electrocardiograms may be able to identify myocardial infarction early and reduce mortality. However, it is unclear whether pre-hospital electrocardiograms can accurately detect occlusive myocardial infarction and how this affects outcomes. This study will analyse the outcomes of patients with occlusive myocardial infarction who had a pre-hospital electrocardiogram. Method Electrocardiograms transmitted to the coronary care unit triage service were identified, along with data regarding patient demographics, referrals and mortality. Data were analysed for correlations between demographic and clinical factors and type of myocardial infarction. Results A total of 838 electrocardiograms were identified; 69 (8.2%) showed myocardial infarction and eight (1.0%) showed occlusive myocardial infarction, of which 50% had ST elevation. Patients with occlusive myocardial infarction were more likely to be triaged to the coronary care unit than patients with non-occlusive myocardial infarction (P=0.04). However, 38 (55.1%) of the patients with myocardial infarction and four (50.0%) of the patients with occlusive myocardial infarction were not directed to a coronary care unit or the catheterisation laboratory. Patients with occlusive myocardial infarction had higher index episode mortality rates (P=0.03) and 30-day mortality rates (P<0.01). Conclusions Despite pre-hospital electrocardiogram transmission and adherence to the guidelines, triage of myocardial infarction and occlusive myocardial infarction is imperfect. Refinement of risk scores and adaptation of new technology is required to help identify patients with occlusive myocardial infarction so they can be prioritised for immediate reperfusion therapy.

AB - Background/Aims Acute coronary syndromes include unstable angina and myocardial infarction, of which occlusive myocardial infarction is a high-risk subset that is often missed because of a lack of ST elevation. Pre-hospital electrocardiograms may be able to identify myocardial infarction early and reduce mortality. However, it is unclear whether pre-hospital electrocardiograms can accurately detect occlusive myocardial infarction and how this affects outcomes. This study will analyse the outcomes of patients with occlusive myocardial infarction who had a pre-hospital electrocardiogram. Method Electrocardiograms transmitted to the coronary care unit triage service were identified, along with data regarding patient demographics, referrals and mortality. Data were analysed for correlations between demographic and clinical factors and type of myocardial infarction. Results A total of 838 electrocardiograms were identified; 69 (8.2%) showed myocardial infarction and eight (1.0%) showed occlusive myocardial infarction, of which 50% had ST elevation. Patients with occlusive myocardial infarction were more likely to be triaged to the coronary care unit than patients with non-occlusive myocardial infarction (P=0.04). However, 38 (55.1%) of the patients with myocardial infarction and four (50.0%) of the patients with occlusive myocardial infarction were not directed to a coronary care unit or the catheterisation laboratory. Patients with occlusive myocardial infarction had higher index episode mortality rates (P=0.03) and 30-day mortality rates (P<0.01). Conclusions Despite pre-hospital electrocardiogram transmission and adherence to the guidelines, triage of myocardial infarction and occlusive myocardial infarction is imperfect. Refinement of risk scores and adaptation of new technology is required to help identify patients with occlusive myocardial infarction so they can be prioritised for immediate reperfusion therapy.

KW - acute myocardial infarction

KW - occlusive myocardial infarction

KW - STEMI

KW - ECG

U2 - 10.12968/bjca.2021.0082

DO - 10.12968/bjca.2021.0082

M3 - Article

SN - 1749-6403

VL - 17

SP - 1

EP - 10

JO - British Journal of Cardiac Nursing

JF - British Journal of Cardiac Nursing

IS - 4

ER -

A nurse-led pre-hospital triage service for identifying patients with occlusive myocardial infarction: a service evaluation: a service evaluation

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Fingerprint

Cite this