International Emergency Medicine
Background: Heart disease and diabetes have been identified as a public health emergency on US-affiliated Pacific Islands. Heart disease is the leading cause of death in the Commonwealth of the Northern Mariana Islands (CNMI).This paper aims to describe compliance with quality metrics for acute myocardial infarctions (AMIs) in patients presenting to the Commonwealth Healthcare Center’s (CHCC) emergency department (ED), the sole hospital in the CNMI.
Methods: This is a retrospective chart review of patients who were diagnosed in CHCC’s ED with an AMI between September 2014 to April 2018. Paper ED logbooks and the electronic medical record system were used to collect data. Inclusion critera were any adult who was diagnosed with AMI. There were no exclusion criteria. The quality metrics analyzed were door to electrocardiogram time (
Results: Out of 491 charts reviewed, 96 cases of NSTEMI and 70 cases of STEMI were found. Native Pacific Islanders comprised 72% of the AMI patients found in this study. The mean door to electrocardiogram (EKG) time was 25 minutes. The mean door to EKG time for STEMI cases was 19 minutes, while the mean door to EKG time for NSTEMI cases was 30 minutes. The mean EKG time for female patients was 39 minutes, while the mean EKG time for males was 15 minutes. In this study population, 44.3% of STEMI cases and 62.9% of NSTEMI cases had door to EKG times greater than the AHA recommended 10 minutes. The mean door to fibrinolysis time for STEMI patients was 55 minutes, with a range of 16 minutes to 3 hours. The percentage of STEMI cases that had a door to fibrinolytics time greater than 30 minutes was 65%.
Conclusion: Pacific Islanders have a disproportionately high representation in the patients with STEMI and NSTEMI. Compliance with quality metrics for door to EKG and door to fibrinolytics was low. Women with myocardial infarctions on Saipan have a 2.5x longer door to EKG time. Further studies should explore why there are disparities between sexes and ethnic populations.