Please use this identifier to cite or link to this item: http://hdl.handle.net/20.500.12857/115188
Title: Impact of the Regional Network for AMI in the Management of STEMI on Care Processes, Outcomes and Health Inequities in the Veneto Region, Italy
Authors: Saia, Mario 
Mantoan, Domenico 
Fonzo, Marco 
Bertoncello, Chiara 
Soattin, Marta 
Sperotto, Milena 
Baldovin, Tatjana
Furlan, Patrizia 
Scapellato, Luisa 
Viel, Guido 
Baldo, Vincenzo 
Cocchio, Silvia 
Buja, Alessandra 
Keywords: health care research;health inequities;hospital management;quality assurance
Keywords Plus: ACUTE MYOCARDIAL-INFARCTION;PERCUTANEOUS CORONARY INTERVENTION;TO-BALLOON TIME;ST-ELEVATION;CARDIAC-CATHETERIZATION;RACIAL-DIFFERENCES;DIRECT AMBULANCE;TRENDS;SEX;MORTALITY
Mesh headings: Models, Organizational;Percutaneous Coronary Intervention;ST Elevation Myocardial Infarction
Secondary Mesh headings: Aged;Aged, 80 and over;Female;Healthcare Disparities;Hospital Mortality;Humans;Italy;Male;Middle Aged;Retrospective Studies
Issue Date: 2018
Publisher: MDPI
Journal: International journal of environmental research and public health 
Abstract: 
Cardiovascular diseases are a leading cause of death in Europe. Outcomes in terms of mortality and health equity in the management of patients with ST-Elevation Myocardial Infarction (STEMI) are influenced by health care service organization. The main aim of the present study was to examine the impact of the new organizational model of the Veneto Region's network for Acute Myocardial Infarction (AMI) to facilitate primary percutaneous coronary intervention (PCI) on STEMI, and its efficacy in reducing health inequities. A retrospective cohort study was conducted on HDRs in the Veneto Region for the period 2007⁻2016, analyzing 65,261 hospitalizations for AMI. The proportion of patients with STEMI treated with PCI within 24 h increased significantly for men and women, and was statistically much higher for patients over 75 years of age (APC, 75⁻84: 9.8; >85: 12.5) than for younger patients (APC, <45: 3.3; 45⁻64: 4.9), with no difference relating to citizenship. The reduction in in-hospital, STEMI-related mortality was only statistically significant for patients aged 75⁻84 (APC: -3.0 [-4.5;-1.6]), and for Italians (APC: -1.9 [-3.2;-0.6]). Multivariate analyses confirmed a reduction in the disparities between socio-demographic categories. Although the new network improved the care process and reduced health care disparities in all subgroups, these efforts did not result in the expected survival benefit in all patient subgroups.
URI: http://hdl.handle.net/20.500.12857/115188
ISSN: 16617827
DOI: 10.3390/ijerph15091980
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