2023-09-28 14:46:10 +00:00
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abstract: 'Introduction: Over the past two decades, India has witnessed a
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staggering increase in the incidence and mortality of ST-elevation
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myocardial infarction (STEMI). Indians have higher rates of STEMI and
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younger populations that suffer from it when compared with developed
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countries. Yet, the recommended reperfusion therapy with fibrinolysis
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and percutaneous coronary intervention is available only to a minority
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of patients. This gap in care is a result of financial barriers, limited
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healthcare infrastructure and poor knowledge and accessibility of acute
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medical services for a majority of its population.
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Methods and analysis: This is a prospective, multicentre,
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`pretest/post-test'' quasi-experimental, community-based study. This
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programme will use a `hub-and-spoke'' model of an integrated healthcare
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network based on clusters of primary-care health clinics, small
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hospitals and large tertiary-care facilities. It is an `all-comers''
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study which will enrol consecutive patients presenting with STEMI to the
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participating hospitals. The primary objectives of the study is to
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improve the use of reperfusion therapy and reduce the time from first
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medical contact to device or drug in STEMI patients; and to increase the
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rates of early invasive risk stratification with coronary angiography
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within 3-24 h of fibrinolytic therapy in eligible patients through
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changes in process of care. Outcomes will be measured with statistical
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comparison made before and after implementing the TN-STEMI programme.
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The estimated sample size is based on the Kovai Erode Pilot study, which
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provided an initial work on establishing this type of programme in South
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India. It will be adequately powered at 80\% with a superiority margin
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of 10\% if 36 patients are enrolled per cluster or 108 patients in three
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clusters. Thus, the enrolment period of 9 months will result in a sample
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size of 1500 patients.
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Ethics: This study will be conducted in accordance with the ethical
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principles that have their origin in the current Declaration of Helsinki
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and `ethical guidelines for biomedical research on human participants''
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as laid down by the Indian Council for Medical Research. All
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participating hospitals will still obtain local ethics committee
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approval of the study protocol and written informed consent will be
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obtained from all participants.
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Dissemination and results: Our findings will be reported through
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scientific publications, research conferences and public policy venues
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aimed at state and local governments in India. If successful, this model
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can be extended to other areas of India as well as serve as a model of
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STEMI systems of care for low-income and middle-income countries across
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the world.'
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affiliation: 'Alexander, T (Corresponding Author), Kovai Med Ctr \& Hosp, Dept Intervent
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Cardiol, Coimbatore, Tamil Nadu, India.
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Alexander, Thomas, Kovai Med Ctr \& Hosp, Dept Intervent Cardiol, Coimbatore, Tamil
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Nadu, India.
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Victor, Suma M.; Mullasari, Ajit S., Madras Med Mission Hosp, Dept Intervent Cardiol,
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Madras, Tamil Nadu, India.
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Veerasekar, Ganesh, Kovai Med Ctr \& Hosp, Dept Epidemiol, Coimbatore, Tamil Nadu,
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India.
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Subramaniam, Kala, Lotus Clin Res Acad Pvt Ltd, Clin Res, Madras, Tamil Nadu, India.
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Nallamothu, Brahmajee K., Univ Michigan, Ann Arbor, MI 48109 USA.'
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article-number: e003850
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author: Alexander, Thomas and Victor, Suma M. and Mullasari, Ajit S. and Veerasekar,
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Ganesh and Subramaniam, Kala and Nallamothu, Brahmajee K. and Investigators, TN-STEMI
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Programme
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author-email: tomalex41@gmail.com
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author_list:
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- family: Alexander
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given: Thomas
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- family: Victor
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given: Suma M.
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- family: Mullasari
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given: Ajit S.
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- family: Veerasekar
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given: Ganesh
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- family: Subramaniam
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given: Kala
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- family: Nallamothu
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given: Brahmajee K.
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- family: Investigators
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given: TN-STEMI Programme
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da: '2023-09-28'
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doi: 10.1136/bmjopen-2013-003850
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files: []
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issn: 2044-6055
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journal: BMJ OPEN
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keywords-plus: HEART
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language: English
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number: '12'
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number-of-cited-references: '9'
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papis_id: ec821bf07ff47f3e9a08c939faa4681e
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ref: Alexander2013protocolprospective
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times-cited: '17'
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title: 'Protocol for a prospective, controlled study of assertive and timely reperfusion
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for patients with ST-segment elevation myocardial infarction in Tamil Nadu: the
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TN-STEMI programme'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000330541400019
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usage-count-last-180-days: '0'
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usage-count-since-2013: '4'
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volume: '3'
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web-of-science-categories: Medicine, General \& Internal
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year: '2013'
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