The hub-and-spoke model of national STEMI programme of India: An investigation of STEMI-Goa project

Abstract

Introduction: Government of Goa initiated ST Elevation Myocardial Infarction (STEMI) – Goa project for achieving the objectives of Ayushman Bharat and Sustainable Development Goals to reduce the premature mortality from non-communicable diseases by one-third with adopting advanced health practices and modern technology. The project handles the escalating STEMI cases in Goa since December 2018. Methods: Mix-method was used for data collection in this study and service statistics was collected from the hub and spoke hospitals. Additionally, staff engaged in the implementation of STEMI model were interviewed. We have visited 13 public health facilities including Goa Medical College where the ‘Hub-and-Spoke’ model of STEMI has institutionalized. The data was collected during October 2019 by employing the pre-designed checklist. Results: All patients who reached the hub-hospital undergone with angiography followed by angioplasty if required. Since the initiation of the project total of 546 patients were diagnosed with the STEMI and 85 percent of patients admitted with a STEMI were thrombolized, – subsequently, 64 percent of them undergone for angiography. Considering the mortality, around 6 percent of deaths have occurred during the past six months. Our study highlights the positive effect of the Hub-and-Spoke model on the treatment of patients with STEMI. The hub-and-spoke model is functioning effectively under the continuous monitoring of expert cardiologists. Additionally, the model has a review committee to investigate deceased cases, advanced cardiac care ambulances and modern ECGs technology. Conclusion: The model can be implemented at a larger scale in other parts of India with the required human resource and advanced technology.

Keywords

• STEMI
• Hub-and-spoke
• Thrombolysis
• Angiography
• Angioplasty
• India