Abstract
Objetivo
El avance en el tratamiento de los síndromes coronarios agudos trata de configurar una asistencia integral, no sólo de acelerar el tratamiento fibrinolítico.
El objetivo del presente trabajo es evaluar medidas básicas de asistencia prehospitalaria de los pacientes con síndromes coronarios agudos.
Diseño
Estudio descriptivo.
Emplazamiento
Hospitalario.
Participantes
Pacientes diagnosticados de infarto agudo de miocardio o angina inestable derivados a unidades de cuidados intensivos de 70 hospitales (registro ARIAM).
Los pacientes se catalogan dependiendo de sus antecedentes coronarios isquémicos previos y al sistema que acuden primero. Se evalúa la atención prestada mediante un score específico, con especial atención en medidas elementales: administración de ácido acetilsalicílico y nitroglicerina y realización de ECG.
Mediciones y resultados
Entre 30.746 pacientes, de los que un 70,4% presentaba infarto agudo de miocardio y el 29,6% angina inestable, con 3:1 de relación varón/mujer, el score medio de atención prehospitaria alcanza un punto. Acude por sus propios medios un 48,5%, haciéndolo el resto por dispositivos de atención urgente. Se administró nitroglicerina al 36,7% y ácido acetilsalicílico a un 13,1%. Entre los pacientes con antecedentes, estas proporciones se mantienen.
Entre los dispositivos tampoco la presencia de antecedentes parece determinar una actitud diferente.
La evolución temporal no ha experimentado cambios espectaculares y las tendencias al alza observadas son más acusadas para las medidas menos establecidas.
Conclusiones
Dentro de la evaluación de la asistencia prehospitalaria a los síndromes coronarios agudos existen numerosas oportunidades de mejora que hay que desarrollar en varios frentes y donde estén implicados todos los estamentos de la asistencia sanitaria.
Palabras clave: Infarto de miocardio, Angina inestable, Medición del proceso, Manejo de pacientes, Dispensa de los cuidados sanitarios
Abstract
Objective
The advance in the treatment of the acute coronary syndromes tries to configure an integral attendance, not only of accelerating the fibrinolityc therapy.
The objective of the present work is to evaluate basic measures of the patients’ out of hospital attendance with acute coronary syndromes.
Design
Descriptive study.
Setting
Hospital center.
Patients
Diagnosed patients of myocardial infartion or unstable angina derived to intensive care units of 70 hospitals (ARIAM registry).
The patients are classified depending on their previous coronary antecedents and to the system that you/they go first. The attention is evaluated by means of an specific score, with special attention in basic measures: administration of acetil-salicilic acid and nitroglycerine and realization of ECG.
Measurements and main
Among 30746 patients, of those that 70.4% was myocardial infartion and 29.6% unstable angina, with 3:1 of relationship male/female, the half score of out of hospital attention reaches 1 point. 48.5% goes for its means, making it the rest for devices of urgent attention. It was administered troglicerina to 36.7% and acetil-salicilic acid to 13.1%. Among the patients with antecedents, these proportions remain.
Among the devices the presence of antecedents seems neither to determine a different attitude.
The temporary evolution has not suffered spectacular changes and the tendence to the observed rise, they are more marked for the less established measures.
Conclusions
Inside the evaluation of the out of hospital attendance to the acute coronary syndromes exist numerous opportunities of improvement that it is necessary to develop to several fronts and where all the sanitary services involved will be implied.
Key words: Myocardial infarction, Unstable angina, Process measures, Patient care management, Health care delivery
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