Retrospective data analysis of  NSTEMI patient management
Creators: name: McColpin, Aaron
Publisher: name: F1000 Research Limited
Year: 2018

description: <i>Background</i><br>Often heart attacks are classified by changes in an electrocardiogram (EKG) that are often referred to as ST Elevation Myocardium Infarction (STEMI) and Non-ST Elevation Myocardium Infarction (NSTEMI). An NSTEMI heart attack has a less critical timeframe with several different management techniques appropriate based risk stratification. Patients with higher risk factors should have an urgent cardiac catheterization within four hours on presentation whereas patients with low-risk factors can be treated within 48 hours with cardiac catheterization or medication therapy. <br><br><i>Purpose</i><br>The study was performed at two county hospitals that serve multiple vulnerable populations including homeless and noninsured.  One hospital is a large tertiary care center and the other is a small community hospital.  At the time of the study presently neither facility had an in-hospital cardiac catheterization laboratory and depend on nearby hospitals to perform angiography followed by revascularization for their patients. The purpose of the study was to evaluate the current performance of the emergency department providers and cardiologist will be evaluated through a retrospective study to determine if the best practice were being met by both entities.  <br><br><i>Method</i><br>The study used a retrospective data analysis of all Non-ST Elevation Myocardium Infarction (NSTEMI) from both county hospital during a 16-month timeframe. A total of 155 patients were identified as having NSTEMI that were seen in the Emergency Departments (ED). <br>All patients diagnosed with an NSTEMI in the ED had chart reviews completed to determine risk category as defined by the American College of Cardiology/American Heart Association guidelines.  Of the 155 patients diagnosed with an NSTEMI, 33 patients were identified for full review. <br><br><i>Findings</i><br>A total of 155 patients were diagnosed with an NSTEMI.  Of the patients diagnosed 33 were found to require further review to determine is current guidelines were met.  Of the 33 patients identified 58% were from the main tertiary care center and 42% were from a community hospital.  The average age of the patient was 64 years old, 73% were male and 27% were female.  Of the 33 patients identified for further review found that 88% (n=29) were found to have care that met the current treatment guidelines.  Four cases (12%) did not receive urgent catheterization within the recommended timeframe.  The four patients that did not meet the current treatment timeframes all had comorbidities of hypertension, diabetes, dyslipidemia, and extensive smoking history. The most common indication found for urgent catheterization being severe/worsening heart failure and persistent angina despite medical therapy. <br>The majority of patients did have current practice guidelines being met with only 2.5% of all NSTEMI (n=155) patients not meeting current practice guidelines. Several issues were found that could be improved to improve care.  First, there was inconsistent documentation of cardiology consultation calls. Second, a critical finding of CHF that complicated the NSTEMI diagnosis was not considered for patients that would indicate an urgent need for cardiac catheterization. Finally, a gap in communication between the on-call cardiologist and interventional cardiologist.