The role of general practitioners in the management of acute myocardial infarction in resource-limited settings
DOI:
https://doi.org/10.56294/shp2024146Keywords:
IAMCEST, reperfusion, prehospital care, general practitioners, primary coronary angioplastyAbstract
Acute myocardial infarction with ST-segment elevation (STEMI) was one of the leading causes of death in Argentina and constituted a medical emergency requiring rapid and effective intervention. Timely care significantly reduced mortality, although challenges persisted in both the prehospital and hospital settings, especially in areas with limited resources. The annual incidence was 128 cases per 100,000 inhabitants, with a hospital mortality rate of 9% and a prehospital mortality rate of 91%. General practitioners played a key role in the diagnosis and initial treatment of STEMI, highlighting the need for training in ECG interpretation, reperfusion options, drug administration, and coordinated work with emergency services. Although primary coronary angioplasty was the treatment of choice, prehospital thrombolysis was used as an alternative in regions with poor infrastructure. Strategies such as ongoing training, the development of care networks, the standardisation of prehospital protocols and the use of technologies such as telemedicine were proposed to overcome the structural barriers of the Argentine health system.
References
1. Gagliardi JA, Charask A, Perna E, D'Imperio H, Bono J, Castillo Costa Y, et al. Encuesta nacional de infarto agudo de miocardio con elevación del ST en la República Argentina (ARGEN-IAM-ST). Rev Argent Cardiol. 2016;84(6):Ciudad Autónoma de Buenos Aires.
2. Adaro D, Celeste V, Alvarado Giménez JS, Morales IL, Vega GG, Gagliardi J, et al. Revista del Consejo Argentino de Residentes de Cardiología. 2021;(pág. 162):Argentina.
3. Bancos Salud. Actualizaciones de médicos de primer nivel [Internet]. Argentina: bancos.salud.gob.ar; 2020 jun [citado 2024 abr 18]. Disponible en: https://bancos.salud.gob.ar/sites/default/files/
4. Kusmana D. Role of general practitioner in the management of acute myocardial infarction. Med J Indones. 1999;14(4).
5. Bridgwood B, Cezar S, Houghton J, Andrew N, Coral P, Sayers R. Medical education in a post COVID-19 era: remote teaching methods for cardiovascular knowledge and skills. MedEdPublish. 2021 Mar;10(62):[publicado en línea].
6. Piombo C, Rolandi F, Fitz MM, Salzberg SI, Strumminger. [Faltan datos clave para referenciar adecuadamente. Por favor completar]
7. Custodio-Sánchez P, Miranda-Noé D, López-Rojas M. Propuesta de manejo inicial del infarto de miocardio con elevación del segmento ST no complicado en centros sin capacidad de intervención coronaria percutánea en el Perú. Arch Peru Cardiol Cir Cardiovasc. 2023 Oct–Dec;4(4):164–83.
8. Delgado-Acosta H, Pedraza-Alejo D, Valladares-Carvajal F, Lastre-Navarro K, Hernández-Torres L, Ávila-Piña D. Calidad de la atención médica a pacientes con infarto agudo. Cienfuegos 2011. Rev Finlay [Internet]. 2013 [citado 2024 jul 12].
9. Fernández HE, Bilbao JA, Cohen Arazi H, Ayerdi ML, Telayna JM, Duronto EA, et al. Registro Multicéntrico SCAR: Rev Argent Cardiol. 2014;82(5):Ciudad Autónoma de Buenos Aires.
10. Fady Y, Zainah M, Gurbinder Kaur JS, Nor Haty H. Identifying educational needs and knowledge gaps in healthcare professionals for effective management of acute myocardial infarction. 2024 Jun;11(6):37–43.
11. Weston CFM, Penny WJ, Julian DG, on behalf of the British Heart Foundation Working Group. Guidelines for the early management of patients with myocardial infarction. BMJ. 1994 Mar 19;308.
12. Folgarait A. Radiografía del infarto en la Argentina. Sociedad Argentina de Cardiología. 2016 nov 7.
13. Fumagalli J, Monsalvo M, Gaglio R, Gil A, Koren L. Ministerio de Salud. Resolución 256. Buenos Aires, AR: 2013 oct 14.
14. Smolderen KG, Spertus JA, Nallamothu BK. Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction. JAMA. 2010;303(14):1392–400.
15. Solla RI, Bembibre Vázquez L, Freire Corzo J. Actualización de “ABCDE en Urgencias Extrahospitalarias”: Manejo del síndrome coronario agudo en urgencias de atención primaria. Cad Aten Primaria. 2011;18:49–55.
16. Costabel JP, Quintana M, Perea J, Lamelas P. Documento de posición sobre la mejoría de la reperfusión del IAMCEST en Latinoamérica. Arch Cardiol Méx. 2024 abr-jun;94(2):Ciudad de México.
17. Pourmand A, Tanski M, Steven D, Hamid S, Raymond L, Fareen Z. Educational technology improves ECG interpretation of acute myocardial infarction among medical students and emergency medicine residents. 2015 jan.
18. Rosende A, García Zamora S, Venentini N. Guía de práctica clínica nacional para la reperfusión del infarto agudo de miocardio. Ministerio de Salud; 2020. Argentina.
19. Stocco Aimoli U, Miranda CH. Competence in ST-segment elevation myocardial infarction management by recently graduated physicians applying for a medical residency program. Arq Bras Cardiol. 2020 ene;114(1).
20. Varela García RJ, Olivera Escalona ÁL, Guarton Ortiz OM, Est Dariannis VI, M. Necesidades de aprendizaje de médicos de atención primaria sobre reperfusión coronaria en el infarto agudo del miocardio. Medisan. 2019 mar-abr;9:3–10.
21. Ayanian JZ, Hauptman PJ, Guadagnoli E, Antman EM, Pashos CL, McNeil BJ. Knowledge and practices of generalist and specialist physicians regarding drug therapy for acute myocardial infarction. N Engl J Med. 1994 Oct 27;331(17).
22. Zylbersztejn H, Rubio E, Ulmete E, Mitelman PDPJ. Registro de calidad de atención del infarto agudo de miocardio en los hospitales públicos de la ciudad de Buenos Aires. Rev Argent Cardiol. 2010 mayo 17;79(2).
Published
Issue
Section
License
Copyright (c) 2024 Kamylla Dayse Dos Santos Lima, Leandro Rodríguez Pardal (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.
