Evaluation of Door-to-Balloon Times After Implementation of a ST-Segment Elevation Myocardial Infarction Network
Insights
Implementing a STEMI network significantly reduced door-to-balloon times for ST-segment elevation myocardial infarction patients. This improvement was observed across various presentation types, enhancing timely treatment for heart attack care.
Area of Science:
- Cardiology
- Health Systems Research
Background:
- ST-segment elevation myocardial infarction (STEMI) necessitates rapid intervention.
- Optimal door-to-balloon (DTB) times are recommended to be under 90 minutes.
- Achieving this goal presents challenges in certain US healthcare settings.
Purpose of the Study:
- To assess the impact of a STEMI network on DTB times.
- To evaluate DTB times at a major metropolitan academic hospital in the southeastern US.
- To analyze DTB time variations based on patient presentation (walk-in, EMS, transfers).
Main Methods:
- A pre-post time series design was employed.
- Electronic medical record data from 127 STEMI patients were analyzed.
- Statistical analysis included one-way ANOVA and post hoc comparisons.
Main Results:
- Overall DTB times significantly decreased post-STEMI network implementation (F2 = 11.66, P < .001).
- Transfer patients showed significant DTB time reductions between periods T1 vs. T3 (P < .001) and T1 vs. T2 (P < .001).
- DTB times generally decreased across most presentation types, excluding T2 for EMS.
Conclusions:
- The establishment of a STEMI network effectively reduced overall DTB times for STEMI patients.
- STEMI networks are a valuable strategy for improving acute myocardial infarction care.
- Further optimization may be needed for specific patient pathways like EMS presentations.
Background:
ST-segment elevation myocardial infarction (STEMI) requires prompt therapy. It is recommended for door-to-balloon (DTB) times to be less than 90 minutes. In the United States, some locations have difficulty meeting this goal.
Objective:
The objective of this study was to determine whether implementation of a STEMI network decreased DTB times at a large, STEMI-receiving, metropolitan academic hospital in the southeastern United States. Furthermore, differences among presentation types, including walk-in, emergency medical services, and transfers, were explored.
Methods:
A pre-post time series study of electronic medical record data was conducted to evaluate the efficacy of a STEMI network.
Results:
The sample included 127 patients with a diagnosis of STEMI, collected during 3 periods (T1, T2, and T3). Patients were primarily White (78.0%) and male (67.7%), with a mean (SD) age of 58.9 (13.9) years. The 1-way analysis of variance revealed a significant difference in overall DTB times, F2 = 11.66, P < .001. Post hoc comparisons indicated longer mean DTB times for T1 compared with T3 ( P < .001) and T2 ( P < .001). When exploring presentation type, 1-way analysis of variance revealed a significant difference in mean DTB times in transfer patients between T1 and T2 ( P < .001) and T1 to T3 ( P < .001). No other statistical differences were noted; however, all DTB times with the exception of T2 for emergency medical services presentation decreased.
Conclusions:
Implementation of a STEMI network was effective at decreasing overall DTB times with patients who presented to the hospital with a diagnosis of STEMI.
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