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- Broers, C J M, et al.
(författare)
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The post-infarction nurse practitioner project : A prospective study comparing nurse intervention with conventional care in a non-high-risk myocardial infarction population.
- 2009
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Ingår i: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. - 1568-5888. ; 17:2, s. 61-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To confirm the feasibility of nurse practitioner interventionin non-high-risk patients with recent myocardial infarction (MI). DESIGN: Observational study. SETTING: Acute coronary care unit in a teaching hospital. METHODS: We performed an open-label feasibility study to identify non-high-risk MI patients and evaluate the outcome of a new nurse practitioner intervention programme. The initial pilot phase served to identify the non-high-risk population. In the subsequent confirmation phase, 500 consecutive non-high-risk post-MI patients with preserved LV function without heart failure were included to receive nurse practitioner management. The nurse practitioner intervention started on transfer from the coronary care unit to the cardiology ward and continued thereafter for up to 30 days. MAIN OUTCOME MEASURES: Time to first event analysis of death from all causes or repeat myocardial infarction. RESULTS: 500 Patients without signs of heart failure or depressed LV function were identified as nonhigh- risk and eligible for inclusion in the nurse practitioner intervention programme. In the implementation phase, none of the patients died and 0.9% developed a repeat myocardial infarction after 30 days of follow-up. Compared with the pilot phase, patients in the implementation phase spent fewer days in hospital (mean 11.1 versus 6.2 days; p<0.001). CONCLUSION: It is feasible to identify non-high-risk post-MI patients, who can be managed adequately by a nurse practitioner. Embedding experienced nurse practitioners within critical care pathways may result in significant decreases in length of hospital stay. (Neth Heart J 2009;17:61-7.Neth Heart J 2009;17:61-7.).
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| 2. |
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| 3. |
- Vermeulen, R P, et al.
(författare)
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Prehospital diagnosis in STEMI patients treated by primary PCI : the key to rapid reperfusion.
- 2008
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Ingår i: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. - 1568-5888. ; 16:1, s. 5-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Primary coronary intervention (PCI) for acute myocardial infarction should be performed as quickly as possible, with a door-toballoon time of less then 90 minutes. However, in daily practice this cannot always be achieved. Prehospital diagnosis of ST-elevation myocardial infarction (STEMI) is of major importance in reducing time to treatment, in particular when patients can be transported directly to a centre with interventional capacities. OBJECTIVES: The aim of the current study was to evaluate the time from prehospital diagnosis of STEMI to balloon inflation and identify factors related to treatment delay in patients directly referred to the catheterisation laboratory of the University Medical Centre of Groningen. METHODS: A cross-sectional descriptive design was used to collect data on patients treated with primary PCI after prehospital diagnosis of STEMI. RESULTS: Median prehospital diagnosis-to-balloon time was 64 minutes for patients directly admitted to the catheterisation laboratory and 75 minutes for patients initially admitted to the coronary care unit. A delay longer than 90 minutes was observed in 18 patients. Higher age was associated with longer delay times (p=0.041). Long delays were not associated with diabetes (p=0.293), time from symptom onset to prehospital diagnosis (p=0.87) or time of day (p=0.09). Initial unavailability of the catheterisation laboratory due to running procedures contributed to longer delay times in ten cases. CONCLUSION: Prehospital diagnosis of STEMI and direct referral to a catheterisation laboratory for primary PCI allows a prehospital diagnosis-toballoon time of less than 90 minutes in 82% of patients. Older patients are at risk of longer delays. (Neth Heart J 2008;16:5-9.).
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