Edition 18

Edition 18 | Winter 2015
STENT FOR LIFE INITIATIVE NEWSLETTER
Welcome to the 18th edition of the
Stent for Life Initiative Newsletter
This is an
interactive newsletter
designed to help you
navigate through the content
quickly and easily.
PG 2: Stent for Life Initiative on the Road to Excellence
In partnership with hospitals, payers, governments and industry partners,
SFL helps to create healthcare models that can deliver more efficient and
improved care to ACS patients from 21 countries in Europe, Asia, Africa and
South America while maintaining or reducing costs.
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PG 3: 2015: A Year in Review
In this part of the Stent for Life Winter newsletter, we’d like to provide you
with the opportunity to look back at the year 2015. We’d like to highlight,
once again, SFL countries’ major achievements, relive the SFL Forum 2015
Conference and the SFL Initiative in Perspective Session at the EuroPCR
2015 Course, and also invite you to browse through the new release of the
SFL How-to-Guide.
MORE…
PG 6: Busy first year for SFL Argentina
SFL Argentina wraps up its first year of being a new affiliate member of the
Stent for Life Initiative.
MORE…
PG 8: STEMI CODE Application for Smartphones: A Technological Tool to Reduce Total Ischemic Time
The Society of Interventional Cardiology of Mexico (SOCIME) develops
an application that functions as a tool to locate the closest hospital with
access to primary angioplasty in order to achieve optimal timing of prehospital care for patients with acute myocardial infarction with ST elevation
(STEMI) and also to serve as a guide for symptom recognition, because
identifying the symptoms has proven to be the cause of biggest delays in
STEMI care in Mexico.
MORE…
PG 9: SFL Forum 2016 Conference Share. Inspire. Learn.
Book your calendar to attend the 5th Annual Conference of the Stent for Life
Initiative: SFL Forum 2016 in Prague, Czech Republic, on 26-27 February
2016.
MORE…
Stent for Life Initiative Newsletter | Edition 18 | Winter 2015
Read more country updates in the upcoming
editions and send your stories to:
[email protected]
1
Stent for Life Initiative on the Road to Excellence
During the seven years of Stent for Life Initiative’s existence, SFL’s mission has remained the same:
Reduce mortality and morbidity of patients suffering from acute coronary syndromes (ACS) by
supporting the implementation of European Clinical Practice Guidelines on Myocardial Revascularization
at national and regional levels. We have accomplished a lot — today patients from 21 countries in
Europe, Asia, Africa and South America benefit from SFL programs. In partnership with hospitals,
payers, governments and industry partners SFL helps to create healthcare models that can deliver more
efficient and improved care to ACS patients while maintaining or reducing costs.
While new SFL member countries are focused on building regional STEMI networks with integrated
EMS infrastructure, the mature SFL countries continue to roll-out ACS patient education programs to
shorten patient and system delays, and thus change the patient risk profile of future coronary events.
One way we are doing this is by keeping patients suffering from acute myocardial infarction from coming
back to the hospital. To ensure that a dedicated nurse and/or education specialist is a member of a
heart team at each 24/7 SFL primary PCI center providing clear discharge instructions to post-STEMI
patients, and thus increasing patient compliance with pharmacology treatment and supporting patient
life style changes, a pilot program Contract4Life|After Myocardial Infarction was initiated in the
Czech Republic, Greece, Portugal, Romania and Spain in 2015. By implementing such a program, we
expect that STEMI patient adherence to pharmacology treatment will increase and the 1 year hospital
readmission rate will decrease, as well as the patient risk profile of future coronary events. Moreso,
SFL member countries will continue to roll-out ACT NOW. SAVE A LIFE public education campaigns
to increase the public awareness in knowing the signs of a heart attack and acting quickly when calling
an ambulance so the best treatment can be received in the fastest possible timeframe. Currently nine
SFL countries implement the program at a national or regional level. Our aim is to facilitate best practice
sharing amongst Stent for Life country communications teams and develop a SFL public campaign best
practice tool to inspire other organizations to follow SFL’s example.
We are proud that the SFL activities’ impact on health care can be validated by clinical and economic
evidence. To measure the SFL impact on STEMI patients’ access to PPCI, the third Stent for Life
ACS market survey in a row will be initiated this year. The ESC member and affiliate countries will be
invited to collect data on reperfusion treatment by using a self-administered questionnaire, and provide
descriptive analysis of the type of reperfusion utilization, time delays, pharmacotherapy and medical
device use at a national level.
To ensure the SFL program’s quality and credibility in SFL member countries, a SFL Guidelines
Adherence Program will be implemented at SFL national levels. SFL Center of Excellence criteria will be
introduced at the SFL Forum 2016 conference on 26-27 February 2016 in Prague, Czech Republic.
The goals of improving patients’ clinical outcomes, expanding access to life saving treatment, and
optimizing cost and efficiency are fundamental to all healthcare systems around the world. We recognize
that only through collaboration and partnership Stent for Life objectives can be achieved, and would like
to encourage you to participate in all SFL activities at a national level.
Zuzana Kaifoszova, SFL Project Manager Europe
Stent for Life Initiative Newsletter | Edition 18 | Winter 2015
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A Year in Review
In this part of the Stent for Life Winter newsletter, we’d like to provide you with the opportunity to look
back at the year 2015. We’d like to highlight, once again, SFL countries’ major achievements, relive the
SFL Forum 2015 Conference and the SFL Initiative in Perspective Session at the EuroPCR 2015 Course,
and also invite you to browse through the new release of the SFL How-to-Guide.
In the year 2015, we were pleased to announce three additions to the Stent for Life family: Argentina,
Tunisia, and South Africa. The SFL Declaration was signed at the SFL Forum 2015 by Prof. Jorge Belardi,
on behalf of the Argentine Society of Cardiology, and Prof. Habib Gamra, President of the Tunisian
Group of Interventional Cardiology. We will celebrate the South African SFL Declaration signing during
the SFL Forum 2016 on February 26-27th in Prague. Additionally, the ESC Congress 2015 was an
important milestone in the development of SFL in the Russian Federation. During the congress, Siberia
- a SFL affiliate, transformed into SFL Russia - a full SFL member, under the leadership of Professor
B.G. Alekyan, President of the Russian Scientific Society of Endovascular Therapies, and Professor E.V.
Shlyakhto, President of the Russian Society of Cardiology.
SFL RUSSIA
Stent for Life in Russia first started in two regions, Krasnoyarsk and Kemerovo. These two Siberian
District regions affiliated with the Initiative in 2012, pioneering the implementation of the SFL principles
in Russia. Three years later, during the ESC Congress 2015 in London, Russia joined the Stent for Life
Initiative at the national level.
The road from SFL Siberia to SFL Russia
SFL GREECE
Emergency Medical Services play a critical role in STEMI networks. To reduce the pre-hospital system
delay caused by the lack of 12-lead ECGs in ambulances, SFL Greece started a pre-hospital diagnosis
and triage programme. Ten ambulances in the Athens area will be equipped with 12-lead ECGs with
teletransmission capability. Securing approvals from Ministry of Health and the EMS, this 6-month pilot
programme is set to continue in 2016.
SFL Greece is piloting pre-hospital diagnosis and triage programme
STEMI INDIA
During its annual conference in Hyderabad in June 2015, STEMI India concluded its 12-month pilot study.
The analysis of the data showed that it is possible to establish a system of care in India by combining
the two strategies: primary PCI and the pharmaco-invasive approach. The implementation of the STEMI
India model of care produced an absolute mortality reduction of 4% and an absolute MACE reduction of
Stent for Life Initiative Newsletter | Edition 18 | Winter 2015
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A Year in Review
5.5%. The government of the state of Telangana in South India has requested that a state-wide STEMI
programme is rolled out next year by STEMI India, servicing more than 35 million.
STEMI India to launch a statewide programme in Telangana
SFL PORTUGAL
SFL Portugal partners with the Ministry of Health to create an innovative link between the primary PCI
database and the national database on mortality. Once implemented, it will allow them to obtain reliable
data at all levels: demographic, clinical, follow-up, and use of medicine and medical devices in patients
undergoing PCI and endovascular treatment of ischaemic stroke.
SFL Portugal partners with Ministry of Health to improve primary PCI
SFL SPAIN
The partnership with the Ministry of Health is a critical factor in the success of the Stent for Life Initiative.
Following the two-day SFL Forum meeting in Vigo in March 2015, SFL Spain was officially invited to join
the writing committee for the Ministry of Health’s strategic plan on ischaemic cardiomyopathy, which is
released every four to five years.
SFL Spain achieves consensus on STEMI Protocols
SFL FORUM 2015 CONFERENCE
SFL country champions and project managers from 15 SFL countries came to Prague to share their best
practice, inspire new member countries, and learn from the experiences of SFL ambassadors across
Europe, Gulf countries and South America. They addressed several aspects of ACS treatment and
STEMI management during the event.
SFL Forum 2015
SFL INITIATIVE IN PERSPECTIVE SESSION AT THE EUROPCR
pcronline.com/EuroPCR/EuroPCR-2015/Stent-for-Life-initiative-in-perspective
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A Year in Review
SFL HOW-TO-GUIDE
The Stent for Life Initiative is a proven successful model for the implementation of STEMI treatment
guidelines. The SFL How-to-guide outlines key operational rules to be followed and gives best practice
examples from SFL countries.
Specifically, the guide outlines how to build the SFL structure with a Country Champion, Steering
Committee, Task Force and National Project Coordinator. Guidance is given on how to map and analyze
access to primary PCI, identify barriers to the use of PCI and developing a three year long strategic plan.
Advice is offered on other important steps including integrating SFL into a government supported
programme, setting up a national ACS/AMI registry, engaging stakeholders and publishing findings.
Sections are devoted to running a public awareness campaign, budgeting and fundraising, and
monitoring systems and measuring success.
There are case studies throughout the guide which show how the principles of SFL have been put into
practice in different countries and how barriers have been overcome.
How to guide PDF file download
Stent for Life Initiative Newsletter | Edition 18 | Winter 2015
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Busy first year for SFL Argentina
We are ending our first year as a member of the Stent for Life Initiative.
This year we have set the following objectives:
1. Integrate the SFL Initiative into our national cardiology community
2. Start mapping the situation of the treatment of STEMI patients in our country
3. Choose model regions to start working in during the next years
1. Integrate the SFL Initiative into our national cardiology community
During this year we have made over 30 presentations at conferences and scientific meetings arround the
country with the aim of presenting the Initiative. Undoubtedly, the most important was the Stent for Life
session at the 41st Argentine Congress of Cardiology where we had the presence of Zuzana Kaifoszova,
Project Manager of SFL Europe, where she inspired us by giving a talk on how the SFL Initiative has
transformed the treatment of STEMI patients in Europe.
2. Start mapping the situation of the treatment of STEMI patients in our country
We have made two online surveys to analyze how centers with and without cath labs treat STEMI
patients.
We want to share a brief summary of our findings:
228 centers with PCI capabilities completed the survey:
•
268 cath labs
•
90% of centers have 24/7 p-PCI capabilities
•
During 2014, these centers performed 39,810 PCI, 21% of which were p-PCI, which corresponds to a rate of 952 PCI and 202 p-PCI per one million inhabitants
•
22% of the centers are part of a STEMI network
•
59% of these centers know and record their door to balloon time
64 centers without PCI capabilities completed the survey:
•
55% of the centers have a cardiologists on call 24 h
•
53% of the centers are part of a STEMI network
•
80% of the centers implement preferably one reperfusion strategy: 41% tranfer STEMI patients for rescue PCI, 33% perform a pharmaco-invasive strategy and 26% refer STEMI patients for primary PCI
•
Streptokinase is the most used fibrinolytic agent in 86% of the centers, 5% have tPA and 6% do not have any kind of fibrinolytic agent.
These surveys will remain open online in order to include all centers in our country.
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Busy first year for SFL Argentina
During our session at the 41st Argetine Congress of Cardiology the preliminary results of the National
STEMI Registry were presented. This first phase of the registry included 1464 patients up to October,
2015 at 247 participating centers.
The average age of the population was 61 years old, 76,5% were male.
The median time from the onset of symptoms to the first medical contact was 175
(75-434) min.
80% of the patients received some kind of reperfusion strategy: 24.4% were
treated with fibrinolytics and 75.6% with PCI (92% with p-PCI, 4.9% with rescue
PCI and 3% with farmacoinvasive strategy).
The global in-hospital mortality was 9,2%, 9,3% in patients treated with
fibrinolytics and 8% in patients treated with PCI.
3. Choose model regions to start working in during the next years
Finally, we are selecting the pilot regions with which we will start working.
Considering the high fragmentation of our health care system, we will adapt every strategic plan to each
of the selected regions.
The participating centers must meet the following requirements:
1. Agree to work to meet the objectives of the SFL initiative
2. Create a multidisciplinary team that includes doctors from the Emergency Department, Coronary Care
Unit and Cath labs.
3. Establish algorythms for STEMI patients following clinical guidelines
4. Record each patient in a common database
This has been a busy first year, we wish to thank the Argentine Society of Cardiology, the Argentine
Federation of Cardiology and the Argentine College of Interventional Cardiologists for their support
in meeting our goals and to our industry partners: Boston Scientific, Philips, Astra Zeneca, Raffo and
Cardiomas.
Jorge Belardi, SFL Argentina Country Champion
Alfonsina Candiello, SFL Argentina Project Manager
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STEMI CODE Application for Smartphones: A Technological Tool to Reduce Total
Ischemic Time
Technology has come a long way in recent years and has shown exponential
growth especially after the emergence of applications for smartphones,
which allow the use of information in a flexible and interactive way. Taking
advantage of these technological advances the Society of Interventional
Cardiology of Mexico (SOCIME) decided to develop an application that
functions as a tool to locate the closest hospital with access to primary
angioplasty in order to achieve optimal timing of pre-hospital care for
patients with acute myocardial infarction with ST elevation (STEMI) and
also to serve as a guide for symptom recognition, because identifying the
symptoms has proven to be the cause of biggest delays in STEMI care in
our country.
App “STEMI Code”
The application has several features aimed to provide the user with easy to
use tools:
Register: The user is able to feed the database interactively with their personal and medical data, risk
factors, medication, etc., thereby being able to calculate their cardiovascular risk.
Symptoms: Described in a narrative text, the clinical symptoms of STEMI are supported by graphs
displaying a symptom recognition tutorial.
Emergency: This is the start-up function of “STEMI CODE”. The application
shows a geo-satellite location of the user and finds the closest hospital
supported by SOCIME. It also shows the distance and suggests the fastest route
to access it. The app then automatically connects the user with the ambulance
service linked to the selected hospital. This is how the multidisciplinary process
alerting emergency services as well as the receiving hospital begins, making it
possible for the STEMI patient to optimize their reaction time.
This application has helped us in providing information to the population and
increasing communication between patients and hospitals, allowing the medical
team to be aware of the location of the patient at all times and be ready on arrival.
Proper use of the application by the patient aids the emergency system
and interventionists in reducing the time from the onset of symptoms to
the opening of the vessel responsible for the event (Total Time Ischemia)
substantially.
Dr. Marco Antonio Alcocer Gamba
Dr. Juan Carlos Perez Alva
Dr. Manuel Odín de los Ríos Ibarra
Dra. Leslie Marisol Lugo Gavidia
Stent for Life Initiative Newsletter | Edition 18 | Winter 2015
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SFL Forum 2016 Conference Share. Inspire. Learn.
Book your calendar to attend the 5th Annual Conference of the Stent for Life Initiative: SFL Forum
2016 in Prague, Czech Republic, on 26-27 February 2016.
21 member and affiliate countries and organisations are part of the growing Stent for Life Initiative
whose mission is to reduce the mortality and morbidity of patients suffering from acute coronary
syndromes (ACS) by supporting the implementation of European Clinical Practice Guidelines on
Myocardial Revascularization at national and regional levels.
Conference objective:
Meet experts from around the globe and share best practices in ACS patient management. Review
a progress of improving clinical outcomes, expanding access, and learn about optimizing cost and
efficiency of STEMI networks.
You should attend if you want to:
• Share the best approach to ACS treatment and organisation of care
• Improve the quality of care of patients surviving the acute heart attack
• Discuss results of SFL economic model evaluations and cost effectiveness of
building regional STEMI networks
While the principal mission of SFL is to address equal access to primary PCI for ACS patients in SFL
member countries, future programmes in SFL mature countries will focus on the quality of primary
PCI systems. We are excited to see that SFL has become a platform where new initiatives are born,
for example Contract4Life|After Heart Attack, an early secondary prevention program, and where
management of complex ACS is addressed.
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