Effect of an integrated care model on ST-segment elevation myocardial infarction management in China: a prospective, multicentre, non-randomised controlled study

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BACKGROUND: Early reperfusion therapy is critical in patients with ST-segment elevation myocardial infarction (STEMI). However, limitations in resources and patient-level and system-level barriers delay the administration of reperfusion therapy. This study evaluated the impact of an integrated care strategy for STEMI management in China. METHODS: This prospective, multicentre, non-randomised controlled study consecutively enrolled patients with acute STEMI, who were admitted to eight tertiary hospitals in different regions of China (August 2015-February 2019). An integrated care model was used in four hospitals (intervention). This model mainly included regular community public education, skills training for the diagnosis and treatment of STEMI in percutaneous coronary intervention-incapable centres, referral system improvement and optimal green channel for primary percutaneous coronary intervention-capable centres. In the other four hospitals (control), usual care of acute myocardial infarction public management and medical health service was provided. The primary outcome was the proportion of patients receiving symptom-to-reperfusion within 12 hours. RESULTS: A total of 6817 patients with acute STEMI were analysed (age (mean±SD): 61±13 years; female: n=1242 (18.2%)). Of those, 2452 and 4365 patients were included in the intervention and control groups, respectively. Between 2015 and 2019, the rates of symptom-to-reperfusion within 12 hours and symptom-to-admission within 12 hours increased in the intervention group (from 65.3% to 91.4%; and from 74.2% to 96.4%, respectively; Ptrend=0.015 for both). In addition, there was no significant difference in door-to-balloon time within 90 min observed among the two groups (adjusted relative risk=0.96, 95% CI: 0.89 to 1.02; p=0.18). Moreover, the rates of in-hospital mortality and major adverse cardiac events exhibited a nearly onefold decrease in the intervention group versus the control group (p<0.001). CONCLUSIONS: Use of an integrated care model focusing on prehospital delay may increase the rate of timely treatment in areas with limited medical resources in China. TRIAL REGISTRATION NUMBER: NCT03928119.

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