Factors Associated with Effectiveness of ST-Segment Elevation Myocardial Infarction Referral system among Thai Hospitals

Vol VI Issue II
DOI: 10.5083/ejcm20424884.189 , Cite or Link Using DOI
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Kitigon Vichairuangthum, Pisamai Jarujittipant, Kietchai Veerayannon

ABSTRACT Objective: To investigate the effectiveness of the referral system (mortality rate and the rates of timely coronary catheterization) among patients with acute ST-segment elevation myocardial infarction (STEMI) patients, to study the effectiveness among hospital factors with different locations, sizes, established periods, hospital categories, and it also analyzed the relationship between the hospital factors and the effectiveness of STEMI referral system in Thailand. Methods: The record forms were used for collecting the secondary data of hospital factors, mortality rate and the rates of timely coronary catheterization from 1,180 hospitals in Thailand. The differences between variables were conducted by one-way ANOVA and the relationship between variables was conducted by multiple regression analysis (MRA). Results: Thailand still has faced both problems, shortage and improper concentration of cardiac catheterization centers. There are no cardiac facilities in most hospitals (89%), especially in the northeast area, the high concentration of cardiac catheterization centers is found in Bangkok (10.42%), and are often located in large hospitals with more than 120 beds (80.77%). Overall STEMI mortality rate is 8.46%, the mortality rate is significantly higher among long-established and government hospitals. The relationship between various factors of hospital to the mortality rate, by MRA have shown that various hospital factors jointly predict trends of the mortality rate at 6 percent (adjusted R2 = 0.062). While the mean rate of timely catheterization statistically better among the hospitals larger than 120 beds, hospitals with cardiac catheterization centers and private hospitals, and by analyzing the relationship between various factors of hospitals by MRA, it was found that various hospital factors can jointly predict trends of the rate of timely treatment at 24 percent (adjusted R2 = 0. 246) Conclusion: The results suggest that the Ministry of Public Health in addition to providing and allocating more cardiac catheterization centers across the country, should develop a better referral system for STEMI patients particularly in the 2nd, 3rd, and 4th health service areas, as well as long-established and government hospitals where problems persist.