CODE STEMI Improves Clinical Outcomes and Cost Efficiency in ST
Elevation Myocardial Infarction Patients at Dr Cipto Mangunkusumo
General Hospital
Abstract
Background : One of the highest causes of cardiac mortality is ST
Elevation Myocardial Infarction (STEMI). Delay in the management of
STEMI patients resulted high mortality, morbidity, and economic burden.
CODE STEMI is a protocol to reduce door to balloon time and improve
patient’s quality care and clinical outcome. Objectives : To determine
the effect of the implementation of CODE STEMI on clinical outcome and
cost efficiency of a quality care of STEMI patients at Dr. Cipto
Mangunkusumo General Hospital. Method: This is a retrospective cohort
study that reviewed 207 medical records of STEMI patients who underwent
primary percutaneous coronary intervention (PPCI) in 2015-2018. The
patients were divided into two groups. The first group was treated prior
to establishing the CODE STEMI and the other group was treated with CODE
STEMI protocol. The primary outcome was to measure in-hospital mortality
and morbidity and total hospital cost between both groups. Secondary
end-points included length of stay (LOS) and Cost Efficient Analysis.
Data analysis was done using Mann Whitney and Chi square test. Results:
There were 72 and 135 patients in Pre‐CODE STEMI and CODE STEMI groups
respectively. In CODE STEMI group, median D2BT was significantly reduced
by 130 min (P< 0.001), median LOS was reduced by 1 day
(P=0.009) and there was cost reduction by approximately USD 1,000. There
were declining trend of in-hospital mortality rates (8.3% vs 4.4%) and
MACE at 30 days (48.61% vs 37.78%). Conclusion: Implementation of CODE
STEMI can improve clinical outcome, reduce length of stay and cost
efficiency of STEMI patients in general hospitals.