{
  "abstract": "Background Early reperfusion therapy is critical in patients with ST-segment elevation myocardial infarction (STEMI). However, limitations in resources and patient-level and system-level barriers delay the administration of reperfusion therapy. This study evaluated the impact of an integrated care strategy for STEMI management in China.Methods This prospective, multicentre, non-randomised controlled study consecutively enrolled patients with acute STEMI, who were admitted to eight tertiary hospitals in different regions of China (August 2015–February 2019). An integrated care model was used in four hospitals (intervention). This model mainly included regular community public education, skills training for the diagnosis and treatment of STEMI in percutaneous coronary intervention-incapable centres, referral system improvement and optimal green channel for primary percutaneous coronary intervention-capable centres. In the other four hospitals (control), usual care of acute myocardial infarction public management and medical health service was provided. The primary outcome was the proportion of patients receiving symptom-to-reperfusion within 12 hours.Results A total of 6817 patients with acute STEMI were analysed (age (mean±SD): 61±13 years; female: n=1242 (18.2%)). Of those, 2452 and 4365 patients were included in the intervention and control groups, respectively. Between 2015 and 2019, the rates of symptom-to-reperfusion within 12 hours and symptom-to-admission within 12 hours increased in the intervention group (from 65.3% to 91.4%; and from 74.2% to 96.4%, respectively; Ptrend=0.015 for both). In addition, there was no significant difference in door-to-balloon time within 90 min observed among the two groups (adjusted relative risk=0.96, 95% CI: 0.89 to 1.02; p=0.18). Moreover, the rates of in-hospital mortality and major adverse cardiac events exhibited a nearly onefold decrease in the intervention group versus the control group (p<0.001).Conclusions Use of an integrated care model focusing on prehospital delay may increase the rate of timely treatment in areas with limited medical resources in China.Trial registration number NCT03928119.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China",
        "Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China"
      ],
      "name": "Yong Liu"
    },
    {
      "affiliations": [
        "Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China",
        "Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China"
      ],
      "name": "Jin Liu"
    },
    {
      "affiliations": [
        "Department of Cardiology, Maoming People's Hospital, Maoming, Guangdong, China"
      ],
      "name": "Yan Liang"
    },
    {
      "affiliations": [
        "Department of Cardiology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, Guangdong, China"
      ],
      "name": "Jianfeng Ye"
    },
    {
      "affiliations": [
        "The Second School of Clinical Medicine, Shunde Hospital of Southern Medical University, Foshan, Guangzhou, China"
      ],
      "name": "Yunzhao Hu"
    },
    {
      "affiliations": [
        "Department of Cardiology, Fujian Medical University Affiliated Longyan First Hospital, Longyan, Fujian, China"
      ],
      "name": "Liling Chen"
    },
    {
      "affiliations": [
        "Department of Cardiology, Shenzhen People's Hospital, Shenzhen, Guangdong, China"
      ],
      "name": "Shaohong Dong"
    },
    {
      "affiliations": [
        "Department of Cardiology, People's Hospital of Yangjiang, Yangjiang, Guangdong, China"
      ],
      "name": "Xiaoyu Huang"
    },
    {
      "affiliations": [
        "Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China"
      ],
      "name": "Mingcai Song"
    },
    {
      "affiliations": [
        "Institute of Control and Prevention for Chronic Non-infective Disease, Guangdong Center for Disease Control and Prevention, Guangzhou, Guangdong, China"
      ],
      "name": "Ruilin Meng"
    },
    {
      "affiliations": [
        "Institute of Control and Prevention for Chronic Non-infective Disease, Guangdong Center for Disease Control and Prevention, Guangzhou, Guangdong, China"
      ],
      "name": "Xueyan Zheng"
    },
    {
      "affiliations": [
        "Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China",
        "Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China"
      ],
      "name": "Yibo He"
    },
    {
      "affiliations": [
        "School of Population Health, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Jing Zhang"
    },
    {
      "affiliations": [
        "The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Xuejun Yin"
    },
    {
      "affiliations": [
        "Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China",
        "Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China",
        "Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China"
      ],
      "name": "Shiqun Chen"
    },
    {
      "affiliations": [
        "Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China",
        "Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China"
      ],
      "name": "Ning Tan"
    },
    {
      "affiliations": [
        "School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China"
      ],
      "name": "Maoyi Tian"
    },
    {
      "affiliations": [
        "Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China",
        "Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China"
      ],
      "name": "Jiyan Chen"
    }
  ],
  "title": "Effect of an integrated care model on ST-segment elevation myocardial infarction management in China: a prospective, multicentre, non-randomised controlled study",
  "uid": "619c2105-c8ce-540d-85c6-484f2f5d5676"
}