Avaliação dos atendimentos a pessoas com síndrome coronariana aguda em um pronto socorro público sem acesso a hemodinâmica

Abstract

Deaths from Acute Coronary Syndrome (ACS) have an important impact in Brazil, was responsible for 31,43% of deaths in 2013. This is related to the fact that developing countries have difficulties accessing reperfusion therapies when in time. There is a gap between practice and established standards for care of patients with ACS. To reduce distancing, SCA Quality Indicators are used as a resource. Thus, it is necessary to evaluate the services that provide care to people with ACS to receive appropriate treatment with early recognition of the infarction and fast referral to other health facilities if indicated. This study aimed to evaluate the results of the visits to patients with acute coronary syndrome admitted to a public emergency room without access to percutaneous coronary intervention. It is a quantitative, descriptive, retrospective study that analyzed the care of patients with ACS from january to october 2016. The patients considered for this study were adult, classified by the Manchester Protocol, with a confirmed diagnosis of ACS and whose symptoms started in less than 24 hours. Data were presented as mean, standard deviation, median, interquartile range (IQ), absolute and relative frequencies. An association analysis was performed between the dependent variable and the outcome of the patient. The software Statistical Package for Social Science version 20.0 was used. Values of p <0,05 were considered significant. There were 92 visits, 65,2% were males, the mean age was 61 (SD: ± 13,45) years. 39,1% of the patients presented a diagnosis of ST-elevation myocardial infarction (STEMI). Chest pain predominated as the main complaint (80,4%) and 70.6% of the patients were assigned the very urgent priority level. The median time between registry and medical care was 33 (IQ: 20,7-59,5) minutes. Of the patients who performed ECG on admission, the time between the patient arrival and the beginning of ECG showed a median of 16 (QI:16-55) minutes. Of the visits with medication registration, 95.5% received AAS and 88.6% P2Y12 inhibitors in the first 24 hours. Almost half of the patients with STEMI (44,4%) underwent chemical thrombolysis, with median time from door to needle 44 (IQ: 32,2-63,7) minutes. As a result, the majority (54,3%) were transferred from the emergency room to hospitals with a hemodynamic service, with a median transfer time of 1876 (IQ: 362-5740) minutes. In the bivariate analysis, there was a significant difference in association with the outcome of the variables: medical diagnosis (p = 0,021) and troponin result (p = 0,002). The outcome of the patient is directly related to the severity of the condition and to the measures taken at hospital admission. There is adherence to established standards for the treatment of ACS. such as requesting cardiac marker tests, performing ECG, and administering specific drugs within the first 24 hours. The institution needs to invest in improving the care process and adopt measures to organize transfer flows to improve the quality indicators related to time between risk classification and medical care door-ECG and door-transfer time, in order to obtain early diagnosis and PCI in a timely manner when indicated