CVREP Foundation – Global Heart Attack InitiativeBy Samar Naguib / February 1, 2023 CVREP Foundation GHATI Email:(Required)Institution Name:(Required)Institution Address (# Street, City, Province, Country) :(Required)Clinical Champion (Name , Title) :(Required)Clinical Champion Email:(Required)Administrator Champion (Name, Title) :(Required)Administrator Champion Email:(Required)INSTITUTION INFORMATIONIs the institution considered to be:(Required) Private Non-Profit Government-funded Other: How many beds are in the institution ?(Required)How many AMI patients are seen/treated at the institution annually?(Required)How many STEMI patients are seen/treated at the institution annually?(Required)Is the institution located in an urban area?(Required) Yes No Is there an ambulance or similar transportation service in place in the area where the institution is located?(Required) Yes No Do more than 75% of acute myocardial infarction (AMI) patients arrive via ambulance?(Required) Yes No If no, what percentage of AMI patients arrive at the institution by ambulance? (Estimation is acceptable):(Required)Which are some of the most common modes of transportation that AMI patients use to get to the institution?(Required)Is there a catherization laboratory at the institution?(Required) Yes No Does the institution use an electronic health record system?(Required) Yes No If no, what type of system is currently in place?(Required)Does the institution have a dedicated clinical research division or department?(Required) Yes No Other Does the institution participate in any other program or initiative in which data is collected and reported with the goal of tracking progress, improvement, etc?(Required) Yes No If so, what other initiatives and/or registries of your institution currently participate in?GHATI is aware that research laws vary country to country, please let us know which of the following your institution would be willing to submit: *(Required) Aggregated totals (mean/medians of the total patient population per quarter) De-identified patient level data Both Other
