24th ASMIHA Coverage: iSTEMI Networking as Cardiovascular Disease Management
JAKARTA --- Networking pilot project for ACS in West Jakarta, namely iSTEMI, aiming to reduce mortality and morbidity due to ACS. Networking is the right technology said Dafsah Arifa Juzar, MD. iSTEMI involve National Cardiac Center Harapan Kita, Cengkareng Hospital, 10 private hospitals and 8 health centers in West Jakarta.
There are an estimated 5026 cases of heart attacks per year in West Jakarta. Data Istemi for 6 months (July-November 2014) there were 1701 cases of ACS in West Jakarta, and one third cases (654 cases) are STEMI. However, only 29% who undergo PCI, 12% fibrinolysis and 59% no reperfusion. According to Dafsah Arifa Juzar, MD, reperfusion level is still low because most patients are late presenters (onset> 12 hours). This marks the patient's awareness of heart attack patients is still low so late in coming to the medical practitioner, plus facilities and hospitals that can perform rapid intervention is still inadequate. Door-to-needle time in the case of fibrinolytic was 85.5 minutes (target 60 minutes) and for the heart center Harapan Kita Hospital, was achieved within 56.5 minutes. Door to balloon time for cases that undergo primary PCI was 169 minutes (target 120 minutes), while on the Harapan Kita Hospital was archieved in 81 minutes. Performance on the Harapan Kita Hospital was better than non cardiac health care center. This is because the system delay, included therein: geographic, awareness of medical personnel and hospital triage.
By bringing the vision of "reperfusion for all STEMI Patients", iSTEMI Network embraces hospital centers and networks in order to work together in a continuous system. This system allows for the exchange of information among hospitals concerning procedures for diagnosis and reperfusion of patients according to the guidelines that have been agreed upon.
iSTEMI program revealed that inadequate reperfusion in West Jakarta region have improved ischemic time, ex the time between the onset of disease and reperfusion. According to Dafsah Arifa Juzar, MD, doctors expertise in informed consent is also required to support the success of this Network iSTEMI system because of the data is known approximately 7.3% of patients refuse reperfusion action.
Collaboration between stakeholders and health practitioners has resulted in local protocol standard that is run by the iSTEMI network in 2014. The protocol includes the management of STEMI patients, fibrinolysis therapy, and a data recap of health facility for STEMI management. In the future, the program begins in West Jakarta will initiate formation of other regional areas to establish the same system so that the scope later includes one Indonesia.
Modified from Media Aesculapius by KM, Edited by Su