Stent for LifeEgypt

Country Champion Prof.Mohamed Sobhy

President of Egyptian Society of Cardiology

Project Manager Dr.Ahmed El Shal

5

Geography & PopulationArea = 1,002,000 km2Nile = 6500 km , the

longest in the worldRed Sea coast = 995 kmMediterranean coast

=1941 kmPopulation ~ Million 82Population 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

6

Egypt Population: Urban vs Rural 1907 - 2009

17 21 27 28 34 38 40 44 44 43 43 45

83 79 73 72 66 62 60 56 56 57 57 59

0

20

40

60

80

100

120

Urban Rural

Excluding Egyptians abroad

% of Population

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

9286 81 81

75 75 72 70 66 64 5949 45 45

35 33 30 30 28 24 23 19 199 8 5

10 7 2 12

53

15

8 1031

1515

40

3528

2635

30

55

2544

3341

2945

714 12 17 13

20 2515

26 26

10

36 40

15

3039 44

3542

21

52

3748 50

6350

0%10%20%30%40%50%60%70%80%90%

100%

CZ SLO DE CH NO DK PL HR SE HU BE IL IT FIN AT FR SK ES LAT UK BG PO SRB GR TR RO

P-PCI Thrombolysis No reperfusion

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

Current situation : patient pathway

Patient

EMS

cathlabICU

HomeLocal hospital

•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

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

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

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.

Stakeholder managementBarriers :No clear mapping cath labs/populationLack of knowledge and implementation of ESC guidelinesMindset change : IC is also a discipline that needs to be available 24/7Infrastructure change

cathlab 24/7clear protocol for EMS

Action itemsMappingContinue with training on ESC guidelinesUse local meetings /symposia/media to create awarenessSelect projects that give “quick” results – communicate resultsOrganise local stakeholder meetings to get buy-in from start

Achievements Since SFL initiative Declaration in Egypt

14th October 2010• Approval of project from Egyptian Society of

Cardiology to secure National endorsement.• Establish the local SFL Steering Committee (12)

and Task force committee (42)

21st November 2010• Meeting of Prof.Fajadet ,Mrs. Zuzana Kaifoszova,

Prof.Sobhy with medical Companies managers to introduce the project in Egypt and secure sponsorship.

Oct. –Nov. 2010

Declaration in Egypt

25th of 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

Gathering Baseline Data

(1 )Need Registry to give ideas

(2 )Ambulance capacity for geographic distribution

(3 )Quality of ambulance

contact center for

refer

(4 )Training programs for

PPCI & ER

(5 )ER plan ministry of

Health

December 2010

Network

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.

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

12th of May 2011• 2nd meeting for Steering committee & Task force committee

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

Details of Plan of Action in 2011

2-  Guidelines implementation and Physician Education

Details of Plan of Action in 2011

Activity Region Dates Target attendeesPhysician Education Program

Delta and Alexandria region

4-5/5/2011Alexandria

300 cardiologists and GPs

ESC Guidelines implementation

Great Cairo region Non Invasive

12-13/5/2011Cairo

400 cardiologists

SFL session in conferences

Cardio Alex 2011 ( 3 sessions)

7-10/6/2011Alexandria

300 cardiologists and GPs

Physician Education Program Upper Egypt region 21-22/7/2011

Hurghada250 cardiologists

and GPs

ESC Guidelines implementation

Delta and Alexandria region

Non Invasive14-15/7/2011

Alexandria400 cardiologists

Physician Education Program Delta and Cairo region 8-9/9/2011

Alexandria300 cardiologists

and GPs

SFL session in conferences Cardio Egypt 2011

19/10/2011Sharm El Sheikh

300 cardiologists and GPs

ESC Guidelines implementation

Upper Egypt region Non Invasive

8-9/12/2011Hurghada

250 cardiologists

Satellites meeting ACS/PCI guidelines in different governorates Monthly basis

50 cardiologists and GPs

EMS staff education program

1st minutes dealing with patient.

Referral to right hospital

Monthly basis

20 EMS staff in 5 governorates

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 TobgyProf.Mahmoud HassaneinProf.Yehia KishkProf.Tarek ZakiProf.Saeid Shalaby

Details of Plan of Action in 2011

** 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.

4-Media campaign

Details of Plan of Action in 2011

Activity Target Dates

Press conference Public and physician 13/5/2011Cairo

Press conference Public and physician 12/2011Cairo

Sms campaign Physician 10/5/2011

Sms campaign Public and physician 5/6/2011

Website Launch Physician 10/5/2011Special SFL leaflet launch Public 7/6/2011

SFL public Meeting Public forum 10/6/2011

SFL public Meeting Public forum 8/2011

 Committees meetings:

Cairo : 12 May 2011Hurghada : 21 July 2011Sharm El Sheikh : 18 October 2011Alexandria : December 2011

Meeting with SponsorsCairo : 12 May 2011Alexandria : 14 July 2011Sharm El Sheikh : 18 October 2011Alexandria : December 2011

Plan of Action in 2011 – Follow up

Thank you….

June 2012See you next year!