The health system characteristics and timely therapy research in the management of patients with acute coronary syndrome in Serbia

UVOD: Akutni koronarni sindrom (AKS) je veoma česta komplikacija ishemijske bolesti srca. Povezan je sa više od 2,5 miliona hospitalizacija širom sveta svake godine. CILJ:Cilj ovog istraživanja bio je da se ispita da li se bolesnici koji žive u Beogradu, Novom Sadu, Nišu i Kragujevcu razlikuju prema vremenu dolaska do koronarne jedinice (KJ) u odnosu na bolesnike iz ostalih delova Srbije,; zatim da se utvrdi koje su karakteristike AKS bolesnika povezane sa blagovremenim dolaskom do koronarne jedinice i koje su karakteristike AKS bolesnika povezane sa dolaskom do koronarne jedinice službom hitne medicinske pomoći (SHMP). METOD: Istraživanje je studija preseka sprovedena na području Srbije u periodu od 01.01.2008. - 31.12. 2011. godine, bazirana na podacima hospitalnog registra za akutni koronarni sindrom u Srbiji (HORACS). REZULTATI: U posmatranom period prosečno vreme od početka pojave simptoma do prijema produžilo se 23 minuta. Prediktori dolaska u bolnicu u vremenu do 3 sata od pojave bola bili su: bolnice koje godišnje prosečno zbrinjavaju do 100 i od 301-500 AKS bolesnika, mesto stalnog boravka u regionu centralna Srbije, Vojvodine, Beograda i Niša. Mesto stalnog boravka u regionu Šumadije i Zapadne Srbije bio je prediktor dolazaska u vremenu preko 3 sata, kao i ženski pol, uzrast bolesnika preko 64+i niže obrazovanje. AKS bolesnici sa dijabetesom imali su 14% veću verovatnoću da dođu posle tri sata. Pozitivna porodična anamneza za kardiovaskularne bolesti, pušači i hiperlipoproteinemija, prethodni infarkt, dolazak SHMP, tipični simptorm i akutni infarkt miokarda sa ST elevacijom (STAIM) i povišene vrednosti triglicerida bili su prediktori dolaska u vremenu do 3 sata. Prediktori dolaska SHMP bili su: ženski pol, uzrast od 64 i više godina, bolnice koje godišnje prosečno zbrinjavaju do 100, od 201-300 i preko 500 bolesnika, mesto stalnog boravka u urbanom naselju generalno, zatim u Novom Sadu i Beogradu i u regionu Jugoistočne Srbije. Nezavršena osnovna škola i viša škola su prediktori dolaska SHMP, kao i nasledni faktor i fizička neaktivnost. U druge prediktore spadali su i: pethodna PCI, prethodni moždani udar, tipična simptomatologija, dijagnoza infarkta, zatim vreme do 3 sata od početka pojave bola, povišene vrednosti glukoze i smrtni ishod. ZAKLJUČAK: Ovo istraživanje omogućava sveobuhvatno sagledavanje teritorijalnih razlika u pogledu zbrinjavanja bolesnika sa AKS, sa odgovarajućim implikacijama koje bi se pre svega odnosile na organizacione aspekte, odnosno reorganizaciju postojegećeg sistema u zbrinjavaju bolesnika sa bolom u grudima u odnosu na lokalne okolnosti.INTRODUCTION:Acute coronary syndrome is a very freaquent complication of ischemic heart disease. It is related to over 2.5 million hospitalizations world wide every year. THE OBJECTIVE: The objective of this study was to investigate wether the Belgrade, Novi Sad, Niš and Kragujevac patients differ in time of arrrival to coronary care unit (CCU) compared to patients from other parts of Serbia; Further, to investigate the characterisrics of ACS patients related to timely arrival to CCU, as well as what were the characterisrics of ACS patients related to arrival with emergency medical service (EMS). METHOD:Cross-sectional study was based on Hospital Registry data of Acute Coronary Syndrome in Serbia (HORACS) and conducted in the period 01.01.2008-31.12.2011. RESULTS: In the observed period the average time from the sypmtoms onset to admission was prolonged for 23 minutes. Predictors of hospital arrival whitin 3 hours after symptoms appearance were: hospitals that in average manage 100 and 301-500 ACS patients, the permanent residence in the Region of Central Serbia, Vojvodina, Belgrade and Niš. The permanent residence in the Region of Šumadija and Western Serbia was the predictor of arrival after 3 hours and over as well as the female gender, age 65+ and lower education. ACS parients with diabetes had 14% higer probability to come after 3 hours. Positive family history of cardiovasculaar diseases, smokers and hyperlypoproteimenia, previous infarct, arrival with EMS, typical symptomatology, acute myicardial infarctiion with ST elevaation (STEMI) and higher level of TGL were predictors of arrival within 3 hours. Predictors of arrival with EMS were: female gender, age 65+, hospitals that in average manage 100, than 201-300 and 500 and over ACS patients, the permanent residence in urban area in general, then in Novi Sad and Belgrade and in the Region of South-Eastern Serbia. the unfinished elementary and college level of education were the predictors of EMS arrival, as well as positive family history and physical inactivity. The other predictors were: previous PCI, previous stroke, typical symptomatology, infarct diagnosis, time from symptom onset within 3 hours, higher level of glucosis and lethal outcome. CONCLUSION: This research provide a comprehensive understanding of territorial differences regarding the treatment of patients with ACS, with corresponding implications which would be primarily related to organizational aspects, ie reorganization of the management system of patients with chest pain in relation to local circumstances