The Barriers to Rapid Reperfusion in Acute ST-Elevation Myocardial Infarction

Area of Science:

• Cardiology
• Public Health
• Healthcare Systems Improvement

Background:

• Acute ST-elevation myocardial infarction (STEMI) requires rapid reperfusion therapy.
• Delays in treatment significantly impact patient outcomes.
• Identifying and addressing obstacles to timely care is essential, particularly in mixed rural/urban settings.

Purpose of the Study:

• To quantify obstacles contributing to delayed reperfusion therapy in STEMI.
• To improve the efficiency of reperfusion treatment delivery.
• To analyze performance across different healthcare trusts in a mixed region.

Main Methods:

• Prospective monitoring of STEMI patients from November 2020 to April 2021.
• Registration of critical time intervals, treatment modalities, and outcomes.
• Involvement of clinical decision-makers as improvement agents with feedback on performance.

Main Results:

• Only 29% of 146 STEMI patients received timely reperfusion therapy.
• Significant variation in treatment times between health trusts observed.
• Key delays identified in electrocardiogram (ECG) interpretation, decision-making, and fibrinolytic administration.

Conclusions:

• Multiple system-level improvements are needed to reduce reperfusion delays.
• Enhanced prehospital thrombolysis is recommended.
• Improved on-site workflow, communication protocols, and prehospital transport education are critical.