Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges

OBJECTIVES: To study the impact of a 'hub and spoke' STEMI management programme on delivery of thrombolysis in the state of Goa. METHODS: A prospective observational study was conducted to assess the 'hub and spoke' model STEMI programme in the state of Goa. Data was collected using predesigned proformas filled at Primary Health Centres or District Hospitals which served as the spokes. Primary programme efficacy outcomes studied were the proportion of eligible patients of STEMI receiving thrombolysis and the time to thrombolysis. Secondary outcome assessed was in-hospital mortality. RESULTS: A total of 2050 number of patients were diagnosed with STEMI between November 2019 and March 2022, of which complete data was available for 1325 patients. After ruling out contraindications, delayed presentations or refusal for treatment, 74.3 % of STEMI patients received thrombolysis. The median window period was 130.83 min with an interquartile range (IQR) of 159.63 min. The median time from presentation to recording ECG was 7.9 (IQR = 11.63) minutes and presentation to cloud diagnosis was 11.78 (IQR = 12.96) minutes. The median time from presentation to administering thrombolysis (Door to Needle time) was 18.48 (IQR = 28.85) minutes. Only 0.22 % patients received inappropriate thrombolysis and the in-hospital mortality was 9.4 %. CONCLUSION: A STEMI programme utilizing the existing manpower and primary health care setup improved 'secondary' level of care to patients by providing thrombolysis to a high percentage of patients in quick time. This may serve as a model to improve the outreach of reperfusion therapy in a resource challenged country like India.