title: Role of primary care physicians in treating patients with ST-segment elevation myocardial infarction located in remote areas (from the REseau Nord-Alpin des Urgences [RENAU], Network).
abstract: BACKGROUND
  European guidelines for ST-segment elevation myocardial infarction (STEMI) encourage healthcare networks to increase rates of, and decrease delays to, reperfusion. We examined the impact of training primary care physicians (PCPs) to use equipment for pre-hospital management of STEMI patients in remote areas.
  
  
  RESULTS
  A network for cardiac emergencies was set up in the French Northern Alps in 2002 and a registry of STEMI patients has been kept since. In 2005, 24 local volunteer PCPs were trained and equipped with electrocardiograms, fibrinolysis kits, and automated external defibrillators to deal with cardiac emergencies in remote areas (>30-minute ambulance travelling time). In this study, when the central call dispatcher received a telephone call from a patient in a remote area reporting chest pain with a high probability of STEMI, the dispatcher sent a mobile intensive care unit (MICU) with an emergency physician on board and asked the local PCP, if available, to manage the patient while awaiting arrival of the MICU. Patients in whom the diagnosis of STEMI was confirmed were taken by MICU to an interventional cardiology hospital. We report on patients who received care from a PCP before arrival of the MICU. Between 2005 and 2010, 4,015 patients were enrolled in the registry; 180 patients were located in a remote area, of whom 140 were in an area covered by a participating PCP. Of the 62 patients attended by a PCP before MICU arrival, 27 received thrombolysis and eight patients with ventricular tachycardia/fibrillation were shocked with an automated external defibrillator by the PCP. Mean times from telephone call to thrombolysis were shorter when the patient was attended by a PCP (45.0 ± 25.5 vs 62.4 ± 23.4 min without intervention; p = 0.003). STEMI diagnosis without contraindication to thrombolysis was confirmed in 26 of 27 patients treated as such by PCPs and 1 patient was diagnosed with a Tako-Tsubo syndrome.
  
  
  CONCLUSIONS
  PCP care of STEMI patients located in isolated areas appears efficient, with high rates of resuscitation and thrombolysis and a shorter delay to reperfusion.
authors: Hospital of Annecy, France University Teaching Hospital of Campus, Lomé, Togo.
authors: Komlavi
authors: K
authors: Yayehd
authors: Hospital of Annecy, France.
authors: Cécile
authors: C
authors: Ricard
authors: Hospital of Annecy, France.
authors: François-Xavier
authors: FX
authors: Ageron
authors: Hospital of Annecy, France.
authors: Léna
authors: L
authors: Buscaglia
authors: Hospital of Annecy, France.
authors: Dominique
authors: D
authors: Savary
authors: Médecins de Montagne, Chambéry, France.
authors: Bernard
authors: B
authors: Audema
authors: Hospital of Annecy, France.
authors: Diane
authors: D
authors: Lacroix
authors: Médecins de Montagne, Chambéry, France.
authors: Manuela
authors: M
authors: Barthes
authors: Médecins de Montagne, Chambéry, France.
authors: Patrick
authors: P
authors: Joubert
authors: Hospital of Annecy, France.
authors: Gaël
authors: G
authors: Gheno
authors: Hospital of Annecy, France loic.belle@wanadoo.fr.
authors: Loic
authors: L
authors: Belle
mesh_terms: D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005602:France; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010819:Physician's Role; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012423:Rural Health / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000379:methods; D061665:Time-to-Treatment; D014187:Transportation of Patients / Q000706:statistics & numerical data
keywords: ST-segment elevation myocardial infarction; primary care physician; thrombolysis