Dr Tammy Pegg

Dr Tammy Pegg
Consultant Cardiologist – Nelson Marlborough Health

Biography

Tammy is a specialist cardiologist with an interest in Heart Failure and non-invasive imaging including cardiac MRI. She graduated with honours from the University of Leeds in 2000. After house officer jobs, Tammy undertook basic medical training at the University of Manchester Hospitals and gained membership to the Royal College of Physicians in 2003.

In 2004 Tammy commenced advanced training in Cardiology in the Wessex Deanery. In 2005 she commenced a PhD in cardiac surgery at the University of Oxford, working with one of the UK’s leading cardiothoracic surgeons. Her work involved improving surgical techniques in patients with heart failure and cardiac magnetic resonance imaging for the assessment of heart function and injury. In 2008 she was awarded her PhD and has been widely published in peer-reviewed cardiology journals. In 2008 she was a finalist for the Vivenne Thomas American Heart Association Young investigator of the year award and the New Zealand Heart Foundation Young Investigator of the year. In addition to clinical work, Tammy is a trustee for both the Nelson Marlborough Cardiology Education trust and the New Zealand Paramedic Education and Research Charitable Trust.

 

The New Zealand Out-of-Hospital STEMI Pathway – why do we need it?

Co- Presenter: Kris Gagliardi

Background: Although timely reperfusion therapy is instrumental in determining outcomes for patients with ST-elevation myocardial infarction (STEMI), the lack of a coordinated approach in regional New Zealand leads to substantial delays in the delivery of time critical treatment.
Methods: A collaborative treatment pathway involving St John and secondary care aiming to deliver either Primary Percutaneous Coronary Intervention (PPCI) or pre-hospital fibrinolysis with routine immediate transfer of eligible patients to a PCI centre was developed, trialled and evaluated in the predominantly rural Nelson and Marlborough region of New Zealand. Using data from ANZACS-QI and St John ePRF data; parameters including pre-hospital ECG transmission, fibrinolysis administration, device and transfer times were evaluated.
Results: Sixty-seven of the 100 consecutive patients with STEMI/presumed STEMI from February 2016 onwards met the eligibility criteria; the initial reperfusion strategy included PPCI (n=35), fibrinolysis (n=31), and medical treatment (n=1). First medical contact (FMC) to device time for PPCI patients was 81 mins (43-194, n=34, 76.5%<120 mins), FMC to pre-hospital needle time was 44 mins (16-78, n=21, 23.8%<30 minutes). First medical contact to arrival at a PCI centre was 75 mins (27-278, n=54, 66%<90 minutes), however door in door out time (DIDO) time for patients presenting to a non-PCI centre was 99 mins (25-248, n=9, 11.10%<30 mins).
Conclusion: A coordinated STEMI pathway can lead to timely arrival at PCI centres and reperfusion therapy for patients that receive PPCI and reasonable FMC to pre-hospital fibrinolysis times. However, poor DIDO times from non-PCI centres require further improvement to achieve equity.