Acute Coronary Syndrome Essay

Acute Coronary Syndrome Essay

Acute Coronary Syndrome Essay

Acute coronary syndrome is a cardiovascular emergency with a high mortality rate that can be prevented through prompt interventions. It is a type of coronary heart disease characterized by decreased blood flow and resultant hypoperfusion of the heart and includes ST-segment elevation myocardial infarction,  non-ST-segment myocardial infarction, and unstable angina (Bhatt et al., 2022). It commonly presents as sub-sternal chest pain or discomfort that may radiate to the left arm with other non-specific features such as dyspnea and sweating. Healthcare professionals require a high index of suspicion to diagnose this condition early and offer timely management since any delay is associated with adverse patient outcomes.

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ST-segment elevation myocardial infarction requires a primary percutaneous coronary intervention which is the reperfusion therapy of choice. Guidelines recommend a door-to-balloon time not exceeding 90 minutes from the arrival at the facility (Park et al., 2019). Treatment delay,  which is an important measure of primary quality of care, can be caused in various points at the course of a patient’s illness.  These include client delay to seek care, duration from symptoms onset to initial medical contact, pre-hospital system delay, in-hospital delay, and door-to-ballon time (Park et al., 2019) Reducing these delays can significantly reduce the risk of mortality and improve patient outcomes and survival.

Strategies have been put in place to reduce door-to-balloon time. These strategies mainly target the aforementioned delays with particular attention to door-to-balloon time components namely door-to-electrocardiogram, electrocardiogram to the catheterization laboratory, and laboratory-to-ballooning. Some of the measures include the provision of pre-hospital electrocardiograms, full-time on-site availability of cardiac healthcare professionals, facility activation of STEMI code, and prompt transfer of patients to catheterization laboratory without the need of going through the emergency department (Salarifar et al., 2019). There is also a need for training of healthcare teams so that they provide effective and efficient healthcare services in conformity with provided current guidelines. More efforts are needed to ensure successful implementation of these strategies.

References

Bhatt, D. L., Lopes, R. D., & Harrington, R. A. (2022). Diagnosis and Treatment of Acute Coronary Syndromes: A Review. JAMA, 327(7), 662–675. https://doi.org/10.1001/jama.2022.0358

Park, J., Choi, K., Lee, J., Kim, H., Hwang, D., & Rhee, T. et al. (2019). Prognostic Implications of Door‐to‐Balloon Time and Onset‐to‐Door Time on Mortality in Patients With ST‐Segment–Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. Journal Of The American Heart Association, 8(9). https://doi.org/10.1161/jaha.119.012188

Salarifar, M., Askari, J., Saadat, M., Geraiely, B., Omid, N., Poorhosseini, H., Amirzadegan, A., Hajzeinali, A., Alidoosti, M., Aghajani, H., Nozari, Y., & Nematipoor, E. (2019). Strategies to Reduce the Door-to-Device Time in ST-Elevation Myocardial Infarction Patients. The Journal of Tehran Heart Center, 14(1), 18–27. https://pubmed.ncbi.nlm.nih.gov/31210766/

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One of the most widespread quality improvement efforts in acute care was the drive to decrease “door to balloon” times for acute coronary syndrome. how this issue was tackled from a quality improvement standpoint? Where are we at now?