Table 1
ACS care continuum framework.
| PHASE | TOPICS | SPECIFIC OUTCOMES REPORTED |
|---|---|---|
| Pre-hospital | Contact with health services | Contacting medial services, emergency medical services activation. |
| Time to medical attention | Symptom onset to first medical contact, emergency services arrival time, scene time, ambulance time, scene to hospital time, symptom onset to presentation, pre-hospital delays. | |
| Diagnosis | Assessment for ACS, tests ordered, pre-hospital ECG. | |
| Treatment | Preadmission treatment, sending mobile ICU, Receiving protocol for MI, pre-hospital thrombolysis, referral to specialist, referral to hospital, use of medication (antithrombotics, analgesia, nitrates). | |
| Events | Cardiogenic shock, cardiac arrest, mortality. | |
| Other | Emergency medical services transport, use of pre-notification. | |
| Diagnosis | Time | Time from door to ECG, time to angiography. |
| Biomarkers | Use of biomarker testing, troponin testing. | |
| ECG | Use of ECG. | |
| Angiography | Use of angiography, radial access. | |
| Echocardiography | Use of echocardiography. | |
| Imaging | Imaging, coronary computed tomography, IVUS, OCT, FFR. | |
| Treatment | Time | Symptom onset to angiography, time from admission to evaluation, ECG to angiography, time to treatment, first medical contact to PCI, Door to balloon time, time to CABG, in-hospital delay. Length of stay, mechanical support, CRP, circulatory support, extra corporeal membrane oxygenation, admission to hospital ward, CCU or ICU, transfer to cath lab. |
| Revascularization | Receiving revascularization, invasive management, PCI, radial access, radial-to-femoral crossover, use of drug eluting stents, use of bare metal stents, plain balloon angioplasty, thrombus aspiration, CABG, medical management. | |
| Reperfusion (STEMI patients) | Reperfusion, thrombolysis, Fibrinolysis, PCI, stent implantation, drug-eluting stents, intra-aortic balloon-pump, aspiration thrombectomy, CABG, angioplasty. | |
| Antithrombotic medications | Medication use, evidence-based medications, guideline recommended medications, optimal medical management: antithrombotics, antiplatelet, aspirin, clopidogrel, prasugrel, ticagrelor, glycoprotein IIb/IIIa inhibitors, P2Y12 inhibitors, dual antiplatelet therapy, anticoagulants, heparin, fondaparinaux, warfarin, bivalirudin. | |
| Antihypertensive medications | Medication use, evidence-based medications, guideline recommended medications, optimal medical management: antihypertensives, beta-blockers, ACE-inhibitors, ARBs, calcium channel blockers, diuretics, vasodilators. | |
| Lipid-lowering medications | Medication use, evidence-based medications, guideline recommended medications, optimal medical management: lipid-lowering, statins, ezetimibe. | |
| Other medications | Medication use, evidence-based medications, guideline recommended medications, optimal medical management: anti-ischemic, nitrates, opioids, oral antidiabetics, insulin, traditional Chinese medicine. | |
| Events | Complications | Cardiovascular complications, stroke, shock, bleeding, cardiac arrest, reinfarction, mitral regurgitation, atrioventricular block, ventricular fibrillation, ventricular tachycardia, arrythmia, pericardial effusion, cardiac tamponade, Mechanical complications, free wall rupture, papillary muscle rupture, ventricular septal rupture, coronary perforation or dissection, side branch occlusion, femoral pseudoaneurism, Respiratory failure, acute kidney injury, nephropathy, pneumonia, gastrointestinal bleeding, prolonged ventilation, CABG-related complications, transradial access failure, stent complications, major adverse cardiovascular and cerebrovascular events, net adverse cardiovascular events. |
| Mortality | In-hospital mortality. | |
| Discharge | Antithrombotic medications | Medication use, evidence-based medications, guideline recommended medications, optimal medical management: antithrombotics, antiplatelet, aspirin, clopidogrel, prasugrel, ticagrelor, glycoprotein IIb/IIIa inhibitors, P2Y12 inhibitors, dual antiplatelet therapy, anticoagulants, heparin, fondaparinaux, warfarin, bivalirudin. |
| Antihypertensives medications | Medication use, evidence-based medications, guideline recommended medications, optimal medical management: antihypertensives, beta-blockers, ACE-inhibitors, ARBs, calcium channel blockers, diuretics, vasodilators. | |
| Lipid-lowering medications | Medication use, evidence-based medications, guideline recommended medications, optimal medical management: lipid-lowering, statins, ezetimibe. | |
| Other medications | Medication use, evidence-based medications, guideline recommended medications, optimal medical management: anti-ischemic, nitrates, opioids, oral antidiabetics, insulin, traditional Chinese medicine. | |
| Advice | Advice on diet and exercise, smoking cessation counseling. | |
| Cardiac rehabilitation | Referral and uptake of cardiac rehabilitation. | |
| Other | Discharge on the same day, discharge to skilled nurse facility. |
[i] ACS = acute coronary syndrome; ECG = electrocardiogram; ICU = intensive care unit; MI = myocardial infarction; IVUS = intravascular ultrasound; OCT = optical coherence tomography; FFR = fractional flow reserve; CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention; ACE-inhibitors = angiotensin-converting enzyme inhibitors; ARBs = angiotensin receptor blockers; CCU = cardiac care unit.
Figure 1
Flowchart of study selection.
Figure 2
Map with number of publications by country.
Figure 3
Mapping of the available evidence by region and care phase.
Figure 4
Number of outcomes and direction by care topic and phase.