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PATHWAYS: ASSESSMENT OF DISTANCE TO PCI AND MORTALITY IN STEMI WITH PROCESS MINING TOOLS
Session:
Painel 5 - E-Cardiologia e Saúde Publica 1
Speaker:
João Borges Rosa
Congress:
CPC 2020
Topic:
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Theme:
35. Research Methodology
Subtheme:
35.2 Research Methodology: Big Data Analysis
Session Type:
Posters
FP Number:
---
Authors:
João Borges Rosa; Manuel Oliveira Santos; Marco Simões; César Teixeira; Sílvia Monteiro; Lino Gonçalves; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p>Introduction: The expected delay of transport between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy in ST-segment elevation myocardial infarction (STEMI). The central region of Portugal has heterogeneity in PCI assess due to geographical reasons. However, this data is usually presented numerically without providing a visual distribution of patients. We aimed to analyse the impact of distance to PCI centres on mortality in patients with STEMI through visual maps of patients’ flow by using an experimental process mining tool, integrated in EIT Health’s project PATHWAYS.</p> <p>Methods: Using the Portuguese Registry of Acute Coronary Syndromes (ProACS), we retrospectively assessed patients with an established diagnosis of STEMI, geographical presentation specified, reperfusion option identified (PCI, fibrinolysis or no reperfusion), short-term outcomes defined as discharge or in-hospital death. With the 2 317 patients that fulfilled the criteria, we used a process mining tool to build national and regional models that represent the flow of patients in a healthcare system, enhancing differences between groups.</p> <p>Results: Colour gradient in nodes and arrows changes from green to red, with green representing a lower number of patients as opposed to red. In the national model, most patients from all regions had PCI. Mortality was similar between PCI and fibrinolysis groups (4%) but higher in those without reperfusion (9%). In the central region model, one third of the patients were more than 120 minutes away from a PCI centre. Despite that, almost one third of these patients had PCI instead of fibrinolysis. In this model, fibrinolytic therapy had higher in-hospital survival rate than PCI (98% vs. 94%). Overall mortality was higher in the central model compared with the national model (6.92% vs. 5%). Central region had less PCI (53% vs. 73%), more fibrinolysis (15% vs. 7%) and more patients with no reperfusion (32% vs. 20%).</p> <p>Conclusion: In the ProACS registry, mortality was higher in the central region compared with national data. Even though global interpretation of these findings is limited by underrepresentation from certain central areas, process mining offers an easily understandable view of patients flow. With its statistical upgrade and continuous development, this tool will facilitate the analysis of big data and comparison between groups.</p>
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