Quality measure study: progress in reducing the door-to-balloon time in patients with ST-segment elevation myocardial
Katsufumi Nishida1, Sean K Hirota, Todd B Seto
1John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96813, USA.
Insights
Implementing a protocol significantly reduced door-to-balloon time for ST-elevation myocardial infarction (STEMI) patients, improving timely reperfusion therapy. This strategy is key for faster treatment and better survival rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Healthcare Management
Background:
- Reperfusion therapy is crucial for ST-elevation myocardial infarction (STEMI) patients, impacting mortality and morbidity.
- Timeliness of reperfusion, particularly percutaneous coronary intervention (PCI), directly correlates with improved patient survival.
- The American College of Cardiology recommends a goal of <90 minutes from initial hospital contact to first balloon inflation for PCI.
Purpose of the Study:
- To evaluate the effectiveness of a protocol designed to reduce door-to-balloon time in STEMI patients.
- To compare door-to-balloon times before and after the implementation of a new protocol.
Main Methods:
- Retrospective review of 131 STEMI patients treated at a PCI-capable hospital.
- Analysis of data from January 2006 to September 2008, encompassing periods before and after protocol implementation.
- The protocol was based on identified factors to shorten the door-to-balloon time interval.
Main Results:
- Median door-to-balloon time decreased from 133 minutes to 67 minutes after protocol implementation (p<0.001).
- The percentage of patients achieving the <90-minute goal increased from 17% to 100% by the third quarter of 2008.
- The study population comprised 61% Asian or Pacific Islander patients.
Conclusions:
- The implemented strategies were effective in significantly reducing door-to-balloon time.
- This observational study supports the adoption of such protocols to improve STEMI treatment timeliness.
- Faster reperfusion through protocol optimization is a key factor in improving STEMI patient outcomes.
Background:
Reperfusion therapy improves both mortality and morbidity in patients with ST-elevation myocardial infarction (STEMI). Timeliness of such reperfusion is an important factor in improving patient survival. For percutaneous coronary intervention (PCI), the American College of Cardiology has recommended a goal of <90 minutes from initial hospital contact to first balloon inflation.
Methods:
The authors retrospectively reviewed 131 patients with a diagnosis of STEMI seen at a PCI capable hospital between January, 2006 and September, 2008, a period of time before and after implementation of a protocol aimed at reducing door-to-balloon time. Sixty-one percent of study population was Asian or Pacific Islander. This protocol was largely based on the identification by Bradley et al. of factors whose modification could shorten this time interval.
Results:
Time to reperfusion was compared between groups before (n=57), and after (n=58) protocol implementation. Median door-to-balloon time for the former group was 133 minutes, interquartile range (IQRs), (25th, 75th percentile; 104.5, 147), and for the latter group 67 minutes, IQRs (56, 80) respectively (p<0.001). Prior to implementation of the protocol, a door-to-balloon time of <90 minutes was achieved in 17% of cases. By the third quarter of 2008, this goal was being met in 100%.
Conclusion:
This observational study provides support for the use of the strategies described as a key for reduction in door-to-balloon time.
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