Point-of-Care Diagnosis of Acute Myocardial Infarction in Central Vietnam

Gerald J. Kost, Amanullah Zadran, Thuan T.B. Duong, Tung T. Pham, An V. D. Ho, Nhan V. Nguyen, Irene J. Ventura, Layma Zadran, Mykhaylo V. Sayenko, Kelly Nguyen
2018 Point of Care  
Objectives: Objectives were to (a) advance point-of-care (POC) education, international exchange, and culture; (b) report needs assessment survey results from Thua Thien Hue Province, Central Vietnam; (c) determine diagnostic capabilities in regional health care districts of the small-world network of Hue University Medical Center; and (d) recommend Spatial Care Paths that accelerate the care of acute myocardial infarction (AMI) patients. Methods: We organized progressively focused, intensive,
more » ... nd interactive lectures, workshops, and investigative teamwork over a 2-year period. We surveyed hospital staff in person to determine the status of diagnostic testing at 15 hospitals in 7 districts. Questions focused on cardiac rapid response, prediabetes/diabetes, infectious diseases, and other serious challenges, including epidemic preparedness. Results: Educational exchange revealed a nationwide shortage of POC coordinators. Throughout the province, ambulances transfer patients primarily between hospitals, rarely picking up from homes. No helicopter rescue was available. Ambulance travel times from distant sites to referral hospitals were excessive, longer in costal and mountainous areas. Most hospitals (92.3%) used electrocardiogram and creatine phosphokinase-MB isoenzyme to diagnose AMI. Cardiac troponin I/T testing was performed only at large referral hospitals. Conclusions: Central Vietnam must improve rapid diagnosis and treatment of AMI patients. Early upstream POC cardiac troponin testing on Spatial Care Paths will expedite transfers directly to hospitals capable of intervening, improving outcomes following coronary occlusion. Point-of-care coordinator certification and financial support will enhance standards of care cost-effectively. Training young physicians pivots on high-value evidencebased learning when POC cardiac troponin T/cardiac troponin I biomarkers are in place for rapid decision making, especially in emergency rooms. Key Words: acute coronary syndrome (ACS), ambulance, cardiac troponin (cTn) I and T, district hospitals, evidence-based medicine (EBM), geographic information systems, hospital levels, Hue University of Medicine and Pharmacy (HUMP), needs assessment, point-of-care (POC) culture, prehospital diagnosis, primary care, small-world networks (SWNs), Thua Thien Hue Province (TTHP), value proposition (Point of Care 2018;17: 73-92) T he long-term collaborative goal is national development of point-of-care (POC) culture, professional practice, and evidencebased decision making in Vietnam. Specific objectives for this research were (a) to compare needs assessment survey results in Vietnam currently versus 1 decade ago, (b) to determine hospital POC instrument and diagnostic capabilities in the regional districts of Thua Thien Hue Province (TTHP), and (c) to recommend designs, technologies, systems logic, algorithms, and Spatial Care Paths (SCPs) that accelerate the care of patients suspected of having acute myocardial infarction (AMI) in the health care smallworld network (SWN)
doi:10.1097/poc.0000000000000167 pmid:30245595 pmcid:PMC6135481 fatcat:undu3hmi3vb7hcvgwq35wsfwnq