Pereira H, SFL 2014

SITUACIÓN STENT FOR LIFE/ACTP PRIMARIA EN

PORTUGAL

Hélder Pereira, SFL ChampionCiudad Real, 4 Jul 2014

Pereira H, SFL 2014

Stent for Life Portugal

Where we started

Quality Assessment

Our Current Program

Market Research Study

Conclusion

Pereira H, SFL 2014

Where we started3

Pereira H, SFL 2014

9286

81 8175 75 72 70

66 6459

4945 45

35 33 30 30 28 24 23 19 19

9 8 5

1

0 72 12

53

15

8 10

31

1515

40

35

2826

35

30

55

25

44

33

41

29

45

714 12

17 1320

25

15

26 26

10

3640

15

3039

4435

42

21

52

37

48 50

63

50

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CZ SLO DE CH NO DK PL HR SE HU BE IL IT FIN AT FR SK ES LAT UK BG PO SRB GR TR RO

P-PCI Thrombolysis No reperfusion

Reperfusion Therapies Differ in Countries(situation in years 2007-2008 for most countries)

Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries.

P. Widimsky et al. Eur. Heart.J. 2010;31:943-957 doi:10.1093/eurheartj/ehp492

Stent for Life

Pereira H, SFL 2014

Reperfusion Therapies (<2008):

Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries.

P. Widimsky et al. Eur. Heart.J. 2010;31:943-957 doi:10.1093/eurheartj/ehp492

Stent for Life

44%

19%

37%

Non

Revascularized

Primary PCI

Fibrinolysis

<200 P-PCI/million/year

Pereira H, SFL 2014

Reperfusion Therapies (2011):

Stent for Life

7%

68%

25%

Non

Revascularized

Primary PCI

Fibrinolysis

299 P-PCI/million/year*Registo Nacional de SCA; SPC

* PNDCCV – Inquérito Unidades de Saúde 2011

Pereira H, SFL 2014

Barriers Identification

E.M.S. network

Communication

with P-PCI Centers

Secondary transport

Stent for Life Portugal

Patients

Only 23% of STEMI

patients call 112

Hospital

Strategic PCI Hospitals

w/o 24/7

Long “System Delay”Long “Patient Delay”7

Pereira H, SFL 2014

Where we are

Pereira H, SFL 2014

Primary PCI Evolution

0

50

100

150

200

250

300

350

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

105 118 125 132152

179

228243

264

299 306

334

From PNDCCV – Inquérito Unidades de Saúde 2013* From APIC Survey 2013

P-PCI/ Million/Year 2002 - 2013

*

Pereira H, SFL 2014

Primary PCI vs Fibrinolysis

855702

878

572421 424 344

1616

1900

24152575

2829

3179 3246

0

500

1000

1500

2000

2500

3000

3500

4000

2006 2007 2008 2009 2010 2011 2012

Fibrinolysis

P-PCI

From PNDCCV – Inquérito Unidades de Saúde 2013

Coronary Care Units

Pereira H, SFL 2014

Primary PCI vs Other PCI

18 21 21 23 24 25 26

0%

20%

40%

60%

80%

100%

2007 2008 2009 2010 2011 2012 2013

P-PCI

Other

Pereira H, SFL 2014

Primary PCI per Regions (2012)

306 291215

453

32

432

0

100

200

300

400

500

Continente Norte Centro LVT Alentejo Algarve

P-PCI 2012

From PNDCCV – Inquérito Unidades de Saúde 2013

Pereira H, SFL 2014

Primary PCI per Regions (2012)

Pereira H, SFL 2014

Primary PCI per Regions (2012 vs 2013)

306291

215

453

32

432

334

291 287

367

256

438

0

100

200

300

400

500

Continente Norte Centro LVT Alentejo Algarve

From PNDCCV – Inquérito Unidades de Saúde 2013

Pereira H, SFL 2014

Quality Assessment

Pereira H, SFL 2014

P-PCI/million/year

Quantity and Quality

Symptoms-FMC//Call 112

EMSSystem Delay

Pereira H, SFL 2014

Quality Assessment

Portuguese Registry of Interventional Cardiology

“Moment” Survey

Market Research Studies

Pereira H, SFL 2014

Portuguese Registry of Interventional Cardiology (RNCI)

Since 2013, all P-PCI centers are sending data to RNCI

Pereira H, SFL 2014

Portuguese Registry of Interventional Cardiology

Benchmark:

Pereira H, SFL 2014

Moment Zero (n=201)May 2011

Moment One (n=196)May 2012

Moment Two (n=244)May 2013

“Moment” Survey(SFL Portugal)

Pereira H, SFL 2014

Symptoms to FMC

0 20 40 60 80 100 120

Moment Zero

Moment One

Moment Two

118

102

90

Symptoms-FMC

Moment Zero

Moment One

Moment Two

(min)

May 2013

May 2012

May 2011

Pereira H, SFL 2014

Patients who called INEM

0%

10%

20%

30%

40%

Moment Zero Momento One Momento Two

33%

38% 37%

Call 112

May 2011 May 2012 May 2013

Pereira H, SFL 2014

Patients who underwent a health institution without P-PCI

P=0,005

0%

10%

20%

30%

40%

50%

60%

70%

Moment Zero Moment One Moment Two

62%

47% 48%

LOCAL

HOSPITAL

May 2011 May 2012 May 2013

Pereira H, SFL 2014

“Door-in-Door-out” Time (DIDO)

85 90 95 100 105 110 115

Moment Zero

Moment One

Moment Two

97

106

115

LOCAL

HOSPITAL

P-PCI

HOSPITAL

P=0,051

Pereira H, SFL 2014

0 20 40 60

Moment Zero

Moment One

Moment Two

55

53

55

(min

)

Time to Treatment

D2B

Pereira H, SFL 2014

Patients Arriving Directly to P-PCI Hospital:

50 min (30-75)

P-PCI

HOSPITAL

96 min (71-146)

P<0,001

“Door-to-Balloon”

(2011-2013)

Pereira H, SFL 2014

Triage Moment Zero Moment One Moment Two p

Red 5.4% (n=8) 10.6% (n=13) 5.7% (n=9) 0.184

Orange 77.7% (n=115) 66.7% (n=82) 78.3% (n=123) 0.042

Yellow 14.2% (n=21) 21.1% (n=26) 13.4% (n=21) 0.147

Other 2.7% (n=4) 1.6% (n=9) 2.5% (n=4) 0.852

Manchester Triage

30

17% 23% 16%

Pereira H, SFL 2014

Time to Reperfusion Therapy

0%

2%

4%

6%

8%

10%

12%

Moment Zero Moment One Moment Two

8%

12%

9%

Treatment Delay < 120 min:

May 2011 May 2012 May 2013

Pereira H, SFL 2014

Stent for Life Portugal

118

102

90

104

88

100

55

53

55

0 100 200 300

Moment Zero

Moment One

Moment Two

Symptoms-FMC FMC-PPCI D2B

Patient Delay System Delay

May 2013

May 2012

May 2011

Quality Control: Moment Surveys

(min)

Pereira H, SFL 2014

Market Research Study

Pereira H, SFL 2014

ACT NOW – SAVE A LIFE

What’s the typical symptom of MI?

24%

28%

27%

4%

5%

21%

Sintomas enumerados têm todos a ver com enfarte

Nenhum sintoma enumerado tem a ver com enfarte

Alguns dos sintomas enumerados têm a ver com enfarte e outros sintomas não

Todos os sintomas enumerados têm a ver com AVC

Alguns dos sintomas enumerados têm a ver com enfarte e outros têm a ver com AVC

Não sei qual o sintoma típico de enfarte

Symptoms related to MI

Any symptoms is related to MI

Some symptoms are related to MI, some other no

All symptoms are related to Stroke

Some symptoms are related to MI, some other are related to stroke

Do not know the typical symptom of MI

Sofia Portela & Rui Menezes

Pereira H, SFL 2014

ACT NOW – SAVE A LIFE

What would you do in case of MI ?

0%

1%

6%

91%

2%

Chamava um médico

Telefonava a um familiar ou amigo

Ia para o hospital de carro

Chamava uma ambulância

Outro

Other…

• Call line Saúde 24 • Press chest• Basic life support• Don’t know

Call a doctor

Call a friend or relative

Go to a hospital by car

Call an ambulance

Other

Sofia Portela & Rui Menezes

Pereira H, SFL 2014

ACT NOW – SAVE A LIFE

3%

95%

1% 0% 1% 0% 0%

Não sei 112 115 117 118 119 202

What’s the emergency number?

Sofia Portela & Rui Menezes

Don’t know

Pereira H, SFL 2014

Patients who called INEM

0%

10%

20%

30%

40%

Moment Zero Momento One Momento Two

33%

38% 37%

Call 112

Pereira H, SFL 2014

Our Current Program

Pereira H, SFL 2014

Stent for Life Programs

SecondaryPrevention

Follow

the

STENT

PrimaryPrevention

STENT

goes to

School

Cost--Effectiveness

StudySSAVE HER LIFE

Pereira H, SFL 2014

Regional Meetings(P-PCI Hospitals, Non-PCI

Hospitals, EMS, Regional Authorities)

North: Jorge Marques

Centre: Marco Costa

Lisbon and Vale do Tejo: Pedro Sousa

Alentejo: Renato Fernandes

Algarve: Jorge Mimoso

North

Center

LVT

Alentejo

Algarve

Pereira H, SFL 2014

Pereira H, SFL 2014

Barriers Identification

E.M.S. network

Communication

with P-PCI Centers

Secondary transport

Conclusions

Patients

Only 23% of STEMI

patients call 112

Hospital

Strategic PCI Hospitals 24/7

Long “System Delay”Long “Patient Delay”

Pereira H, SFL 2014

Thank you