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Stent for Life Egypt

Stent for Life Egypt. Country Champion Prof.Mohamed Sobhy President of Egyptian Society of Cardiology Project Manager Dr.Ahmed El Shal. Geography & Population. Area = 1,002,000 km2 Nile = 6500 km , the longest in the world Red Sea coast = 995 km Mediterranean coast =1941 km

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Stent for Life Egypt

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  1. Stent for LifeEgypt

  2. Country Champion Prof.Mohamed SobhyPresident of Egyptian Society of CardiologyProject Manager Dr.Ahmed El Shal

  3. Geography & Population • Area = 1,002,000 km2 • Nile = 6500 km , the longest in the world • Red Sea coast = 995 km • Mediterranean coast =1941 km • Population ~ Million 82 • Population Growth Rate: 1.9% • Net Migration Rate: • 21 migrants/ 100,000 population • Literacy = 71.4% • Illiteracy decreased from 39.4% of population in 1996 to 29.3% in 2006 • Percentage of university graduates increased from 5.7% in 1996 to 9.6% in 2006

  4. Egypt Population: Urban vs Rural 1907 - 2009 % of Population Excluding Egyptians abroad

  5. Current situation for Egypt • pPCI rate is around 5 – 8 % • No accurate data available • Different types of hospitals : • University hospitals • Military hospitals • Government/medical insurance hospitals • Private hospitals • National EMS number exists but is not widely used • Government hospital cathlabs are not open 24/7 • Private hospitals are well structured some of them cathlabs available 24/7 • Patient are not aware of AMI symptoms and importance of Time. Patients rather wait for “their” physician • Interventional cardiology is a rather new discipline • Lack of overall awareness with key stakeholders on “Time is muscle” for AMI patients September 2010 Getting started

  6. Reperfusion Therapies P.Widimsky et al. November 19, 2009. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur. Heart.J.doi:10.1093/eurheartj/ehp492 Egypt

  7. Patient EMS cathlab ICU Local hospital Home Current situation : patient pathway • Calls cardiologist • Calls private hospital • Calls physician from private insurance • Calls EMS • DENIAL • Only ambulance from specialised cardiac hospitals have a physician on board • Not properly trained • ECG only on board in new ambulances • No clear unified protocol • Will drive patient to nearest hospitals • If private insurance : will go to private hospital • Not all are open 24/7 • Lack of awareness of how to treat an AMI patient • Cathlab not prepared for AMI patients • Logistic obstacles

  8. SFL Project proposal • Country steering committee with key stakeholders • spokespeople for projects – communicate with media, during congresses and with government • Select people who endorse, support and drive the projects • Key spokesperson : Prof . Mohamed Sobhy • National coordinator/ Project manager : Dr Ahmed El Chal • Liaise with central SFL committee • Representatives of sponsoring companies • Task forces in 5 regions • Alexandria : • best organised region • Great Cairo region : • already individual projects in 3 University hospitals and a project in the National Heart Institute on AMI data gathering • Delta region and Upper Egypt : • rural areas, key focus areas for government • Military Hospitals Group : • strong network, very disciplined, low on bureaucracy, easy to implement protocols October 2010 Proposal

  9. SFL Project proposal • For each region : • decide on key stakeholders • Presentation to “sell” concept to make sure everyone agrees and sees the importance of the project • Stakeholders need to decide on Task Force • Select pilot center and develop into “centre of excellence” • Work with “train the trainer concept” • Develop detailed plan • Gather baseline data • Develop budget • Set clear objectives Define milestones and deliverables • Put measurements in place • Regular feedback into country Steering Committee

  10. Stent for Life Project – Egypt Objectives • Integrate SFL into National Cardiology Program • Build Regional Network and Infrastructure (EMS) • Optimize Cath Lab Staffing and Work Organization • Allocate Budget (Procedure reimbursement & 24/7 staff remuneration) • Establish National ACS/AMI Registry • Increase Disease Awareness (Educational campaign to government, payers and lay public) • EMS staff training is more important that the EMS staff structure (trained nurses suitable for the triage and transport of AMI patients) • EMS ambulances: equipped by resuscitation facilities and by a portable 12-leads ECG. • Raising public awareness about heart attacks and importance to reach the nearest medical centre. • Criteria of selection of patient receiving PCI for SFL program. • Create a database of current PPCI practice patterns in Egypt in order to serve as a benchmark for further assessment. • Improve the performance of centers doing PPCI. • Adequate training of ER & all concerned staff. • Increase patients awareness of the seriousness of chest pain & the dangers of delaying adequate medical care. • Improving emergency services with regional maps for different centers.

  11. Stakeholder management Barriers : No clear mapping cath labs/population Lack of knowledge and implementation of ESC guidelines Mindset change : IC is also a discipline that needs to be available 24/7 Infrastructure change cathlab 24/7 clear protocol for EMS Action items Mapping Continue with training on ESC guidelines Use local meetings /symposia/media to create awareness Select projects that give “quick” results – communicate results Organise local stakeholder meetings to get buy-in from start

  12. Achievements Since SFL initiative Declaration in Egypt 14thOctober 2010 • Approval of project from Egyptian Society of Cardiology to secure National endorsement. • Establish the local SFL SteeringCommittee (12) • and Task force committee (42) • 21stNovember 2010 • Meeting of Prof.Fajadet ,Mrs.ZuzanaKaifoszova, Prof.Sobhywith medical Companies managers to introduce the project in Egypt and secure sponsorship. Oct. –Nov. 2010 Declaration in Egypt

  13. 25thof November 2010 • 1st meeting for Steering committee & Task force committee • Set Project objectives ,Project outlines • Meeting by region including member allocated from Steering & Task force committees : • Current situation in Egypt , Determine each region tasks and ideas. • Decide on key stakeholders • Select pilot center and develop into “centre of excellence” • Brain storming for a detailed plan , Gather baseline data • 26th of November 2010 • Meeting for committees with Minister of Health in Egypt & Ambulance Service Manager • Presentation to “sell” concept to make sure everyone agrees and sees the importance of project • Develop 2011 action plan around key barriers • and success factors • Set clear objectives

  14. December 2010 Network

  15. January - March 2011 Hold on all projects Revolution of 25th of January 2011 in Egypt delayed the start of Action Plan due to some social, administrative and political obstacles.

  16. 12th of May 2011 • 2nd meeting for Steering committee & Task force committee Plan of Action- Strategy All details to be achieved over 3 quarters of the year instead of 4. Working in all Network items in same time. Start a media campaign in same time to gain all positive effects from Egyptian revolution . Unifying cost of pPCI (Companies-Medical insurance) April 2011 Regain our Action Plan

  17. Details of Plan of Action in 2011 1- Registry and Questionnaire / Data base collection • Registry and Questionnaire / Data base collection • Delivery of the questionnaire Approved from SFL European board. • Minimum of 100 questionnaires from each center/university. • Minimum of 10 questionnaires from each committee member(apart from center/university data) • Registry and Questionnaire Launched during 2nd Meeting of Steering and Task Force committees on 12th of May 2011. • Deadline of questionnaires’ collection 20/9/2011

  18. Details of Plan of Action in 2011 • 2-  Guidelines implementation and Physician Education

  19. Details of Plan of Action in 2011 3-Pilot center- Pilot Centers’ Inspection and Audit committee • Pilot center detection • Announcement for Requirements • Application form to be sent to centers (upon centers request to be a pilot center) • Approval of centers applicants Qualifications from the nominated committee. • Pilot Centers’ Inspection and Audit committee (PCIA) • Prof.Sherif El Tobgy • Prof.MahmoudHassanein • Prof.YehiaKishk • Prof.TarekZaki • Prof.SaeidShalaby

  20. ** Duties of PCIA committee • PCIA committee will approve the qualifications of applicant pilot centers. • PCIA committee will organize 2 visits in 2011 for inspection of applicant pilot centers . • PCIA committee will report to steering committee of pilot centers evaluation.

  21. Details of Plan of Action in 2011 • 4-Media campaign

  22. Plan of Action in 2011 – Follow up • Committees meetings: • Cairo : 12 May 2011 • Hurghada : 21 July 2011 • Sharm El Sheikh : 18 October 2011 • Alexandria : December 2011 • Meeting with Sponsors • Cairo : 12 May 2011 • Alexandria : 14 July 2011 • Sharm El Sheikh : 18 October 2011 • Alexandria : December 2011

  23. Thank you….

  24. See you next year! June 2012

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