Editorial
ARIAM, 25 years saving hearts
ARIAM, 25 años salvando corazones
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"apellidos" => "Llanos Jorge" "email" => array:1 [ 0 => "celinallj@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Ramos de la Rosa" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.Á." "apellidos" => "Rodríguez Esteban" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Quirónsalud Tenerife, Santa Cruz de Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Registro ARIAM, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "ARIAM, 25 años salvando corazones" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2019 the ARIAM project (Analysis of delays in acute myocardial infarction) celebrated its 25th anniversary. Created in East Andalusia, Spain back in 1994 as a tool for the assessment and improvement of healthcare in patients with acute myocardial infarction, the registry has evolved and adapted to scientific evidence and clinical practice guidelines on the management of acute coronary syndrome (ACS). Since 2010, ARIAM is part of the Cardiological Intensive Care and CPR Working Group (GTCIC-RCP) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Back in May 2012 it gained public recognition as a Registry of Interest for the National Healthcare System by the Spanish Ministry of Health, Consumer Affairs, and Social Welfare.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the diagnostic and therapeutic advances made over the last few decades, ischemic heart disease is still the leading cause of death in Spain.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Due to its high impact, it is essential to develop global strategies that, through a multidisciplinary and coordinated approach, improve the management of ACS. The intensivist plays an important role in all this for his capacity of leadership since he takes a global approach by conditioning and uniting the efforts from different specialists for the sake of the patient.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand, to elaborate these strategies it is essential to obtain valid, true, representative, and detailed information that will allow healthcare providers and managers to design the most adequate interventions. As its strategic plan says, SEMICYUC<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> commits itself to developing registries that will allow the adequate assessment of such information for strategic planning purposes. In this context, the creation of the ARIAM registry shows us the big picture on the management of patients with ACS in Spain by providing valuable information at demographic, epidemiological, and healthcare level both of the process and the results. Through the analysis of this information the ARIAM registry sets 2 basic goals: improve quality in the management of ACS and generate knowledge.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Council of Europe defines healthcare as the «degree to which the treatment dispensed increases the patient's chances of achieving the desired results and diminishes the chances of undesirable results, having regard to the current state of knowledge».<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> However, this may be an abstract concept difficult to quantify, which means that it is necessary to have tools available for monitoring and assessment purposes. To this end, the ARIAM project has developed 27 indices (of structure, process, and results) to assess the quality level of healthcare in the management of ACS, find weaknesses, implement actions for improvement, and conduct comparative analyses.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> By reviewing quality indices in the critically ill patient<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> it is obvious that patients with ACS really matter to SEMICYUC because this Spanish society gives intensivists recommendations and tools to guide their actions. In this sense, «don’t do» recommendations have been published<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> and their implementation is closely associated with the management of patients with ACS since they deal with issues like indication for amines, pulmonary artery catheter monitoring or indication for mechanical care.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The second goal of this registry—generate knowledge—is closely related to improving healthcare. It is the analysis of information that will allow us to generate hypotheses that will eventually lead to studies, interventions, and results that will need to be reassessed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">These 25 years of history of the ARIAM project, with over 23<span class="elsevierStyleHsp" style=""></span>000 patients included in the registry, have allowed us to conduct numerous studies that have produced articles, communications, doctoral theses, and dissertations. These studies have allowed us to assess and analyze the use of health resources in pre- and in-hospital areas,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> and access to different treatments.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7,8</span></a> Similarly, they have facilitated the analysis of different therapeutic strategies and their results<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> in isolation and in association with demographic data<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> and coronary risk factors.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Another essential tool provided by the ARIAM registry are result reports through which participant researchers and citizens can have access to the global analysis of the information collected by connecting to SEMICYUC official website. By reading such reports we can see the evolution of clinical practice in the management of ACS through time. It should be mentioned that healthcare times have been reduced over the last few years within the quality standards published.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Also, the percentage of patients who receive coronary reperfusion has improved progressively. Since 2013 thrombolytic therapy has been gradually replaced by percutaneous coronary intervention as the treatment of choice for the management of ACS. Thrombolysis has had a leading role in the out-of-hospital setting and centers with no access to cardiac catheterization laboratories. Finally, we should mention here the increase seen over the last few years in the severity and complexity of patients admitted to the ICU with a diagnosis of ischemic heart disease as confirmed by the Killip classification, the TIMI system, and the Grace Score.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">These reports have established protocols for the management of ACS and educational campaigns aimed at the population have been designed to achieve shorter action times to reduce the ACS driven overall mortality by combining the 2 registry endpoints. Despite its longevity and undeniable value, the ARIAM registry faces new challenges in its 25th anniversary like an update of the registry format, recruitment of more centers and researchers or the promotion of scientific production while keeping its identity and goals intact. However, all challenges are a possibility for improvement <span class="elsevierStyleItalic">per se</span> so we remain confident that these challenges will be conquered successfully thanks to the versatility, altruism, and spirit of cooperation of all health professionals who manage critically ill patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Llanos Jorge C. ARIAM, 25 años salvando corazones. Med Intensiva. 2020;44:207–209.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Instituto Nacional de Estadística. Las 15 causas de muerte más frecuentes en España [Internet]. 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Sánchez-Román" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Intensiva [Internet]" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "280" "paginaFinal" => "288" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluación de resultados tras la implantación de un protocolo de fibrinólisis extrahospitalaria en zonas rurales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Hernández-García" 1 => "J.J. Giménez-Ruiz" 2 => "J.M. Dueñas-Jurado" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Semer Med Fam [Internet]" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "440" "paginaFinal" => "448" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Informe ARIAM 2018 [Internet]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.A. Rodríguez Esteban" 1 => "C. Llanos Jorge" 2 => "O. Badallo Arévalo" 3 => "L. Riesco de Vega" 4 => "M.P. Fuset-Cabanes" 5 => "R. Gómez López" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2018" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack460560" "titulo" => "Acknowledgements" "texto" => "<p id="par0045" class="elsevierStylePara elsevierViewall">We wish to thank all the researchers who, every year, participate in this registry, all members in charge of coordinating the ARIAM registry, and the former and present Cardiological Intensive Care and CPR Working Groups for their efforts to create, maintain, and improve this registry. Thank you all because without your invaluable participation ARIAM 25th anniversary would have never seen the light of day.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004400000004/v1_202005050638/S2173572720300497/v1_202005050638/en/main.assets" "Apartado" => array:4 [ "identificador" => "406" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004400000004/v1_202005050638/S2173572720300497/v1_202005050638/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572720300497?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 40 | 40 | 80 |
| 2024 September | 47 | 28 | 75 |
| 2024 August | 58 | 51 | 109 |
| 2024 July | 37 | 36 | 73 |
| 2024 June | 49 | 43 | 92 |
| 2024 May | 41 | 34 | 75 |
| 2024 April | 42 | 30 | 72 |
| 2024 March | 38 | 26 | 64 |
| 2024 February | 29 | 31 | 60 |
| 2024 January | 37 | 31 | 68 |
| 2023 December | 35 | 42 | 77 |
| 2023 November | 51 | 44 | 95 |
| 2023 October | 33 | 24 | 57 |
| 2023 September | 29 | 37 | 66 |
| 2023 August | 34 | 18 | 52 |
| 2023 July | 33 | 23 | 56 |
| 2023 June | 30 | 18 | 48 |
| 2023 May | 43 | 38 | 81 |
| 2023 April | 27 | 15 | 42 |
| 2023 March | 58 | 25 | 83 |
| 2023 February | 79 | 25 | 104 |
| 2023 January | 31 | 15 | 46 |
| 2022 December | 52 | 26 | 78 |
| 2022 November | 63 | 35 | 98 |
| 2022 October | 45 | 33 | 78 |
| 2022 September | 33 | 27 | 60 |
| 2022 August | 31 | 29 | 60 |
| 2022 July | 24 | 36 | 60 |
| 2022 June | 32 | 14 | 46 |
| 2022 May | 29 | 29 | 58 |
| 2022 April | 30 | 31 | 61 |
| 2022 March | 32 | 53 | 85 |
| 2022 February | 26 | 27 | 53 |
| 2022 January | 26 | 34 | 60 |
| 2021 December | 46 | 38 | 84 |
| 2021 November | 43 | 35 | 78 |
| 2021 October | 66 | 66 | 132 |
| 2021 September | 33 | 22 | 55 |
| 2021 August | 38 | 43 | 81 |
| 2021 July | 30 | 28 | 58 |
| 2021 June | 25 | 21 | 46 |
| 2021 May | 41 | 38 | 79 |
| 2021 April | 98 | 66 | 164 |
| 2021 March | 72 | 22 | 94 |
| 2021 February | 74 | 36 | 110 |
| 2021 January | 47 | 18 | 65 |
| 2020 December | 65 | 21 | 86 |
| 2020 November | 40 | 21 | 61 |
| 2020 October | 17 | 8 | 25 |
| 2020 July | 16 | 10 | 26 |
| 2020 June | 28 | 15 | 43 |
| 2020 May | 63 | 26 | 89 |
| 2020 April | 74 | 14 | 88 |
| 2020 March | 1 | 0 | 1 |
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