This project will extend current ST-Elevation Myocardial Infarction (STEMI) management to address healthcare inequalities and higher mortality rates in rural patients resultant from presentation to non-percutaneous coronary intervention (PCI) capable hospitals, requiring lengthy and sometimes multiple transfers. The project will strengthen the District’s systems of care and increase utilisation of services by reducing patient transfer out of the District, and reducing costs for patient transport. This model of care will be readily translatable across rural NSW, helping to reduce the inequities between rural versus metropolitan STEMI outcomes in terms of both definitive revascularisation rates and mortality.
The research questions are whether a centralised STEMI management system and immediate NSW Ambulance transfer of all STEMI patients to a PCI centre will improve times to reperfusion and reduce total patient length of stay.
The project is a non-randomised, prospective, controlled trial of a centralised, District-wide STEMI management system implemented by NSW ambulance and all hospitals within the Western NSW Local Health District. Key aspects of the management intervention include mandated transmission of all STEMI ECGs to the District ECG reading service at first contact; immediate cardiologist contact to assist patient management and transfer; and immediate “hot transfer” of all STEMI patients to PCI capable hospitals. All STEMI patients of the Western NSW Local Health District centralised management system over a 24-month period will be included in the study, and outcomes compared with historical controls and to contemporary control groups from Hunter New England and Sydney local health districts.
Anticipated benefits of the project include reduced time to reperfusion for STEMI patients in Western NSW Local Health District; decreased length of stay and unwarranted clinical variation; streamlined patient journeys with quicker access to definitive care and decreased number of hospital and ambulance transfers experienced by rural STEMI patients; improved angiography and revascularisation rates.
Collaborators: University of Sydney (School of Rural Health -Orange NSW), Agency for Clinical Innovation (cardiology), Hunter New England Local Health District, NSW Ambulance