62 Cross border stemi programme – ‘evaluating outcomes three years following its establishment’

Cross border cooperation between the health sectors of neighbouring states can play a vital role in ensuring certain patient populations have adequate access to essential health services that may otherwise be delayed or forgone in their native countries. County Donegal is unique within the Republic of Ireland in that its STEMI patients have benefited from urgent access to Primary PCI care delivered in Altnegalvin Hospital, Derry, UK, since the establishment of the cross border programme between the Western Social Trust, UK and SAOLTA HSE group, ROI in 2016. Prior to this agreement, patients, were typically administered thrombolysis and transferred to the nearest primary PCI centre within the Republic of Ireland, either Galway University Hospital or Dublin, a 3.5 and 3 hour distance by ambulance, respectively. The region was previously an outlier in terms of access on account of its remote geographical location and a significant evidence practice gap existed, with patients deprived of access to PPCI care in accordance with best practice guidelines. Aims To evaluate outcomes from the first three years of cross border programme. Methods Retrospective case control study Review of electronic health records and patient charts undertaken. Outcomes measured included first positive ecg & ecg to balloon times, 30 day & 1 year mortality, readmissions & length of stay. Data across the three years 2017 – 2019 analysed as well as compared between individual years. 30 day mortality; readmission rates & length of stay analysed against comparator group which included all patients with a coded diagnosis of STEMI discharged within the three years (2013 – 2015) prior to programme establishment. Inclusion criteria: all accepted transfers considered to be ‘true activators.’ Results 196 patients from Donegal were accepted for transfer in the three year period. There were 22 false activations (11%.) 161 cases underwent primary PCI. 124 (71%) were male. The mean age was 67 years (12.5). No significant difference in baseline characteristics was observed between years 2017 – 19. Comparator groups were well matched. Median time to first positive ECG was 12’18’’. The mean time from ECG to wire-crossing was 110 min (65) for patients transferred from LUH and 82 (28) for direct community transfers. Overall mean time to reperfusion was 90 (43) minutes. 120 out of 161 (74.%) patients who underwent PCI were reperfused within 120 minutes. The culprit lesion was the LAD in 51 cases (32%), LCx in 21 (13%) & RCA in 72 (45%). Multivessel PCI was carried out in nine (5.6%) cases, while staged PCI occurred in 41 (25%). Of the total number of patients who underwent PCI (161), seven died within 1 year (4.3%), three of whom (1.9%) died within 30 days. Overall, eleven patients (6.3%) died within one year, with seven (4%) of these dying within the first 30 days. The median LOS was 6. 30 day readmission rate was 11.5%% (20/174,). Of these, 15 (8.6%) were cardiovascular. fourteen (8%) patients bled within 1 year. 30 day mortality was significantly lower among STEMI patients post establishment of cross border programme than in the previous 3 years (4% versus 11.2% p 0.019.) Conclusion Collaboration has enhanced access to PPCI in Donegal. Significant reductions in 30 day mortality observed in patients treated within programme.