Urban vs rural STEMI patients; is there a difference?
Rushworth, Gordon F.
Leslie, Stephen J.
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KAMONA, A., CUNNINGHAM, S., RUSHWORTH, G.F. and LESLIE, S.J. 2016. Urban vs rural STEMI patients; is there a difference? Presented at NHS Highland research, development and innovation annual conference, 25 Nov 2016, Inverness, UK.
Background: Timely access to reperfusion therapy for ST elevation myocardial infarction (STEMI) is vital. Every minute of delay costs 10 days of patient's life. Patients living in the rural Scottish highlands face a lot of challenges to optimum reperfusion therapy (ORT), due to geographical and environmental barriers that influence receiving pharmacological or interventional therapy timeously. Aims: looking at ORT comparing remote vs urban patients. Methods: Patients admitted, between March 2014 and April 2015, were selected from Raigmore hospital STEMI electronic database. A data collection form was developed by the research team and piloted. Clinical details were collected retrospectively from patient's discharge letters. 132 patients who suffered STEMI were included. Data collected included; patients' treatment location, date of admission, distance to the nearest cardiac-unit (CU), MI location, route of access to health, LV function and reperfusion therapy received. Results: 132 patients were identified, 73% received percutaneous coronary intervention, 31.7% received pre-hospital thrombolysis, 24.8% received in-hospital thrombolysis while 13% didn't receive any treatment. From this cohort 51% lived more than 50 miles from the nearest CU. Further analysis is ongoing to identify who received ORT and in the remaining cases what barriers limited ORT. These barriers will be divided into modifiable and non-modifiable. Conclusion: From initial analysis of the results it seems that there is a differential in patients' care, with more rural patients potentially receiving sub-optimal reperfusion therapy. This is likely to have an adverse mortality outcome. More research required to determine if addressing barriers to ORT is achievable and cost effective.