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. 2023 Oct 25;18(10):e0284915.
doi: 10.1371/journal.pone.0284915. eCollection 2023.

Stent for life initiative in Portugal: Progress through years and Covid-19 impact

Ernesto Pereira  1   2   3 , Rita Calé  3 , Ângela Maria Pereira  4   5   6 , Hélder Pereira  3   7 , Luís Dias Martins  8
Affiliations

Stent for life initiative in Portugal: Progress through years and Covid-19 impact

Ernesto Pereira et al. PLoS One. .

Abstract

Background: During Stent for Life Initiative in Portugal lifetime, positive changes in ST elevation myocardial infarction treatment were observed, by the increase of Primary Angioplasty numbers and improvements in patients' behaviour towards myocardial infarction, with an increase in those who called 112 and the lower proportion attending non primary percutaneous coronary intervention centres. Despite public awareness campaigns and system educational programmes, patient and system delay did not change significantly over this period. The aim of this study was to address the public awareness campaign effectiveness on peoples' behaviour facing STEMI, and how Covid-19 has affected STEMI treatment.

Methods: Data from 1381 STEMI patients were collected during a one-month period each year, from 2011 to 2016, and during one and a half month, matching first lockdown in Portugal 2020. Four groups were constituted: Group A (2011); Group B (2012&2013); Group C (2015&2016) and group D (2020).

Results: The proportion of patients who called 112, increased significantly (35.2% Group A; 38.7% Group B; 44.0% Group C and 49.6% Group D, p = 0.005); significant reduction was observed in the proportion of patients who attended healthcare centres without PPCI (54.5% group A; 47.6% Group B; 43.2% Group C and 40.9% Group D, p = 0.016), but there were no differences on groups comparison. Total ischemic time, measured from symptoms onset to reperfusion increased progressively from group A [250.0 (178.0-430.0)] to D [296.0 (201.0-457.5.8)] p = 0.012, with statistically significant difference between group C and D (p = 0.034).

Conclusions: During the term of SFL initiative in Portugal, patients resorted less to primary health centres and called more to 112. These results can be attributed the public awareness campaign. Nevertheless, patient and system delays did not significantly change over this period, mainly in late years of SFL, probably for low efficacy of campaigns and in 2020 due to Covid-19 pandemic.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Proportion of patients who met recommendations of the European Society of cardiology for total ischemic time < 120 minutes.
Fig 2
Fig 2. Proportion of patients call for help by calling 112 and Linha Saúde 24.
Fig 3
Fig 3. Proportion of patients who attended healthcare facilities without possibility to perform primary percutaneous coronary intervention; and proportion of patients who attended primary care before First Medical Contact.
(PPCI) Primary Percutaneous Coronary Intervention; (FMC) First Medical Contact.
Fig 4
Fig 4. Time in minutes from arrival to primary percutaneous coronary intervention hospital (PPCI-H) to Catheterization laboratories (CathLab).
Fig 5
Fig 5. Time to diagnosis confirmation measured in minutes.
FMC-ECG FMC–ECG: Time from first medical contact to electrocardiogram.
Fig 6
Fig 6. Time to treatment and its subdivisions in minutes.
Total ischemic time: Time from onset symptoms to revascularization; Patient Delay: Time from onset symptoms to first medical contact; System Delay: Time from first medical contact to revascularization.
Fig 7
Fig 7. Proportion of patients who met recommendations of the European Society of cardiology
First medical contact to electrocardiogram (ECG ≤10 min); First medical contact to reperfusion (system delay ≤ 90 min; time from onset symptoms to reperfusion.
See this image and copyright information in PMC

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