Changes in the baseline characteristics, management and outcomes of acute myocardial infarction in Estonia
Date
2012-12-17
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Abstract
Eestis on suremus südame veresoonte ateroskleroosi tõttu viimasel aastakümnel oluliselt langenud, ometi paikneme Euroopas edetabelis endiselt esikolmikus. Probleemiks on just kõrge suremus töövõimelise elanikkonna seas. Üks tõsisemaid südame veresoonte ateroskleroosi avaldusvorme on südamelihase infarkt ehk kärbumine, mis võib lõppeda surmaga. Siiski saab kaasaegsete tõenduspõhiste ravivõtete viivitamatul rakendamisel patsientide ravitulemusi, sh elulemust, oluliselt parandada.
Aastal 2001. tehtud uuring näitas Eestis suuri lahknevusi südamelihase infarktiga patsientide ravikäsitluses ja -tulemustes erineva ravitasemega haiglates. Seetõttu on viimase kümnendi jooksul palju panustatud ravikäsitluse parandamisele ja ühtlustamisele. Lisaks tõenduspõhiste raviskeemide kasutamise rõhutamisele on üheks prioriteediks olnud võimaldada suuremale osakaalule patsientidest väheinvasiivset ravimeetodit, kus südame veresoontes taastatakse verevool mehhaaniliselt.
Antud uuring näitas, et ajavahemikul 2001 ja 2007 oli südamelihase infarktiga patsientide ravikäsitlus Eestis paranenud nii kõrgema kui madalama etapi haiglates. Siiski kõrgema etapi haiglates oli areng rohkem väljendunud, mis tõi kaasa ka paremad ravitulemused võrreldes madalama etapi haiglatega. Ometigi ei väljendunud parem ravikäsitlus oluliselt paremates ravitulemustes haigla etapi piires. Probleemiks on eelkõige patsientide kõrgem vanus ja kaasuvate haiguste sagedam esinemine. Muuhulgas näitasid töö tulemused, et just suhkurtõvega naissoost patsientidel on risk halvematele ravitulemustele.
Kokkuvõtteks võib uuringutulemustest järeldada, et nii kõrgema kui madalama etapi haiglates on võimalusi ravikäsitluse ja -tulemuste parandamiseks, seejuures võtmeküsimuseks oleks erineva ravitasemega haiglate koostöö. Eestis on vaja jätkata südamelihase infarktiga patsientide ravikäsitluse ja -tulemuste seiret.
Mortality due to coronary heart diseases has decreased in Estonia during the last decade, still being among the highest in Europe. One of the most serious manifestations of coronary heart disease is acute myocardial infarction, also known as heart attack, which is accompanied by a high risk of death. The prompt use of modern evidence-based strategies makes it possible to considerably improve the outcomes, including survival. A study conducted in 2001 showed important differences in the management and outcomes of patients with myocardial infarction in hospitals providing different levels of care. Therefore much effort has been put into improving and harmonizing the quality of management. In addition to emphasizing the use of evidence-based medications, one of the main priorities has been to enable more patients to receive a minimally invasive management method, in which the blood flow in the vessels of the heart is restored mechanically. Our study demonstrated that in Estonia between 2001 and 2007 the management of patients with myocardial infarction improved considerably both in hospitals of higher and lower level of care. However, the developments were more pronounced in the higher level of care setting, which translated also into better outcomes compared to those seen in lower care hospitals. Nevertheless, the better management did not result in significantly better outcomes within a level of care setting. Higher age and higher rates of co-morbidities pose a challenge for the management of myocardial infarction. In particular, we found that women with diabetes have a high risk for worse outcomes. In conclusion, the study suggests possibilities of improving the management and outcomes of patients with myocardial infarction in both the higher and the lower level of care hospitals in Estonia. The key issue would be the cooperation between hospitals of different levels of care. Further surveillance of the management and outcomes of patients with myocardial infarction in Estonia is crucial.
Mortality due to coronary heart diseases has decreased in Estonia during the last decade, still being among the highest in Europe. One of the most serious manifestations of coronary heart disease is acute myocardial infarction, also known as heart attack, which is accompanied by a high risk of death. The prompt use of modern evidence-based strategies makes it possible to considerably improve the outcomes, including survival. A study conducted in 2001 showed important differences in the management and outcomes of patients with myocardial infarction in hospitals providing different levels of care. Therefore much effort has been put into improving and harmonizing the quality of management. In addition to emphasizing the use of evidence-based medications, one of the main priorities has been to enable more patients to receive a minimally invasive management method, in which the blood flow in the vessels of the heart is restored mechanically. Our study demonstrated that in Estonia between 2001 and 2007 the management of patients with myocardial infarction improved considerably both in hospitals of higher and lower level of care. However, the developments were more pronounced in the higher level of care setting, which translated also into better outcomes compared to those seen in lower care hospitals. Nevertheless, the better management did not result in significantly better outcomes within a level of care setting. Higher age and higher rates of co-morbidities pose a challenge for the management of myocardial infarction. In particular, we found that women with diabetes have a high risk for worse outcomes. In conclusion, the study suggests possibilities of improving the management and outcomes of patients with myocardial infarction in both the higher and the lower level of care hospitals in Estonia. The key issue would be the cooperation between hospitals of different levels of care. Further surveillance of the management and outcomes of patients with myocardial infarction in Estonia is crucial.
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Keywords
südameinfarkt, ravi, ravitulemused, Eesti, myocardial infarction, treatment, treatment outcomes