Strategies for reducing the door-to-balloon time in acute myocardial infarction

Area of Science:

• Cardiology
• Healthcare Management
• Public Health

Background:

• Prompt reperfusion is critical for ST-elevation myocardial infarction (STEMI) patients.
• Guidelines recommend a door-to-balloon time of ≤90 minutes for primary percutaneous coronary intervention (PCI).
• Many hospitals struggle to consistently meet this crucial time benchmark.

Purpose of the Study:

• To identify specific hospital strategies associated with reduced door-to-balloon times.
• To analyze the effectiveness of various protocols in accelerating STEMI treatment.

Main Methods:

• Surveyed 365 hospitals regarding the adoption of 28 predefined strategies.
• Utilized hierarchical generalized linear models and Medicare/Medicaid patient data.
• Correlated hospital strategies with observed door-to-balloon times.

Main Results:

• Six strategies significantly reduced door-to-balloon times, including physician-led lab activation (8.2 min reduction) and central paging systems (13.8 min reduction).
• Emergency department activation while patient is en route (15.4 min reduction) and on-site attending cardiologists (14.6 min reduction) were also effective.
• Real-time data feedback (8.6 min reduction) and rapid staff response (≤20 min, 19.3 min reduction) showed significant improvements, yet few hospitals employed these.

Conclusions:

• Specific hospital-level strategies demonstrably shorten door-to-balloon times for STEMI patients.
• Implementation of these effective strategies remains limited across surveyed hospitals.
• Adoption of these protocols could improve timely reperfusion therapy for myocardial infarction.