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May 14, 2026European Heart Journal Acute Cardiovascular Care

Enhancing prehospital management of acute coronary syndrome: a continuous improvement approach

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Why the study?

Variability in adherence to evidence-based protocols in Brazil's prehospital emergency care presents a major barrier to effective STEMI care.

Does a structured continuous improvement program integrating Lean principles and telehealth improve ACS care processes in prehospital emergency care?

Population

Patients with ACS in Brazil's fixed prehospital units

Comparison

Continuous improvement program integrating Lean, Improvement Science, and telehealth vs baseline

Design

Continuous quality improvement study

Key result

A structured continuous improvement program integrating Lean principles and telehealth increased adherence to thrombolytic therapy from 52% to 60% (p<0.01) in prehospital ACS care.

Authors

CTC TothAAA AraujoARA Ribeiro

Discussion

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Overview

Enhances thrombolytic adherence in acute care; extends support for targeted quality-improvement protocols in MI.

Key Points

  • The study aims to improve prehospital management of acute coronary syndrome (ACS) using continuous improvement programs.
  • Integrated Lean Healthcare principles with Improvement Science methodologies and telehealth strategies.
  • Monitored ACS care process indicators in Brazilian fixed prehospital units over a defined period.
  • Collected data on adherence to thrombolytic therapy and critical time metrics for ACS management.
  • Adherence to thrombolytic therapy increased from 52% at baseline to 60% (p<0.01).
  • Median door-to-needle time decreased from 58 to 42 minutes (28% reduction), p<0.001.
  • Total prehospital length of stay decreased from 797 to 534 minutes (33% reduction).

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

Does a structured continuous improvement program integrating Lean principles and telehealth improve ACS care processes in prehospital emergency care?

P
Population
Patients with Acute Coronary Syndrome (ACS), specifically ST-elevation myocardial infarction (STEMI), managed in Brazil's fixed prehospital units.
I
Intervention
Structured continuous improvement programs integrating Lean Healthcare principles, Improvement Science methodologies, and telehealth strategies (telediagnosis and cardiology teleconsultation).
C
Comparator
Baseline care processes prior to the intervention.
O
Outcome
ACS care process indicators including adherence to thrombolytic therapy, door-to-needle time, and door-to-ECG time.

Main Result

Absolute Event Rate: 60% vs 52%

p-value: p=<0.01

Integrating Lean principles and telehealth in prehospital emergency care significantly improves critical ACS care process metrics such as door-to-ECG and door-to-needle times.

Cite This Study

Toth et al. (2026) conducted an observational in Acute Coronary Syndrome (ACS). Structured continuous improvement program integrating Lean principles and telehealth vs. Baseline (pre-intervention) was evaluated on Adherence to thrombolytic therapy (p=<0.01). A structured continuous improvement program integrating Lean principles and telehealth increased adherence to thrombolytic therapy from 52% to 60% (p<0.01) in prehospital ACS care.

synapsesocial.com/papers/6a0567d2a550a87e60a1ffcbhttps://doi.org/10.1093/ehjacc/zuag046.165
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Improvement in Cardiovascular Outcomes Using Telemedicine to Support Medical Decision in Acute Coronary Syndrome: Experience of Prehospital Public Emergency Care Units in Brazil2025 · 1 citations
  2. 2Coordinated regional care of myocardial infarction in a rural area in Brazil: Minas Telecardio Project 22016 · 29 citations
  3. 3Bridging the gap in acute coronary syndrome care in low and middle income countries through a digital platform2025
  4. 4Effect of a Multifaceted Intervention on Use of Evidence-Based Therapies in Patients With Acute Coronary Syndromes in Brazil2012 · 116 citations
  5. 5Optimising care of acute coronary syndromes in three Australian hospitals2004 · 13 citations