Advantages and challenges of tracking st-segment elevation myocardial infarction patients with a real-time dashboard:
Egidio de Mattia1, Filippo Paoletti2, Daniela Pedicino2
1Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy.
Insights
Implementing a real-time digital dashboard significantly improved timely primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) patients. This enhanced STEMI management, leading to better patient outcomes.
Area of Science:
- Cardiology
- Health Informatics
- Healthcare Management
Background:
- Timely primary percutaneous coronary intervention (pPCI) is critical for ST-segment elevation myocardial infarction (STEMI) outcomes.
- Treatment delays in STEMI are strongly linked to increased morbidity and mortality.
- Optimizing STEMI management pathways is essential for improving patient survival rates.
Purpose of the Study:
- To outline the steps for establishing a real-time digital monitoring dashboard for STEMI care.
- To assess the impact of this dashboard on achieving timely pPCI within 90 minutes.
- To enhance clinical performance in managing STEMI patients.
Main Methods:
- Developed detailed algorithms for STEMI diagnosis, treatment, and follow-up phases.
- Identified critical clinical pathway points and patient flagging rules using risk scores.
- Employed interrupted time series analysis and logistic regression to evaluate dashboard impact on pPCI rates.
Main Results:
- The proportion of patients receiving timely pPCI increased from 40% to 65% post-implementation.
- Adjusted models showed a twofold increase in the odds of meeting the 90-minute benchmark (OR = 2.00).
- The digital monitoring system demonstrated a significant positive effect on STEMI treatment timeliness.
Conclusions:
- Real-time monitoring systems positively impact STEMI management efficiency.
- Implementation of digital dashboards can improve healthcare delivery for acute cardiac events.
- This approach holds potential for enhancing patient outcomes in STEMI care.
Background:
Timely primary percutaneous coronary intervention (pPCI) is the most important treatment to improve outcomes in ST-segment elevation myocardial infarction (STEMI), with a strong relationship between treatment delays and morbidity and mortality. The present study aims to define the main steps for setting up a real-time digital monitoring dashboard to improve the clinical performance of STEMI management and to evaluate the impact of its implementation on the proportion of patients receiving primary percutaneous coronary intervention (pPCI) within 90 min.
Methods:
The set-up of the digital monitoring system required the definition of detailed algorithms for the diagnosis, treatment, and rehab/follow-up phase. For each patient with a diagnosis of STEMI included in the clinical pathway (CP) a multidisciplinary working group identified i) rules for flagging patients alongside the CP, based on specific risk scores; ii) the critical points of the CP to be monitored, such as door-to-balloon time, intensive care unit length of stay, and total hospital length of stay. An interrupted time series analysis and multivariable logistic regression models were performed to assess for changes in the outcome (pPCI within 90 min) after the platform implementation, adjusting for temporal and individual confounders.
Results:
After the introduction of the dashboard, the proportion of timely pPCI improved from 40 % pre-implementation to 65 % post-implementation. Adjusted models indicated a twofold increase in the odds of meeting the 90-minute benchmark (OR = 2.00; 95 % CI: 0.99-4.12).
Conclusion:
The real-time monitoring system showed a positive impact on the timely management of STEMI, highlighting the potential for improving healthcare efficiency and patient outcomes.
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