Summary of Improvements in Door-to-Balloon Time
Every year, almost 250,000 people experience ST-Elevation Myocardial Infarction (STEMI), which is the deadliest type of heart attack. The ACC/AHA clinical practice guidelines for STEMI recommend that STEMI patients presenting to a hospital with PCI capability should be treated with primary PCI within 90 minutes of first medical contact as a systems goal. This analysis used data from the Centers for Medicare and Medicaid (CMS), which collect information from all hospitals with PCI-capable catheterization laboratories, and it summarized patient and hospital characteristics to determine whether or not gains were shared equally. Interestingly:
The study found that 91% of patients who require the emergency artery-opening PCI were treated within the recommended time of less than 90 minutes in 2010, compared with 44% in 2005.
From 2005 to 2010, the median time from hospital admission to emergency angioplasty declined from 96 to 64 minutes.
The paper reports that the declines in median times were greatest among groups that had the highest median times during the first period: those >75 years of age, women, and African Americans.
According to the paper, "These findings highlight what can be achieved through improving the systems of healthcare delivery through collaboration."
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Improvements in Door-to-Balloon Time in the United States, 2005 to 2010
Harlan M. Krumholz, Jeph Herrin, Lauren E. Miller, Elizabeth E. Drye, Shari M. Ling , Lein F. Han, Michael T. Rapp, Elizabeth H. Bradley, Brahmajee K. Nallamothu, Wato Nsa, Dale W. Bratzler, and Jeptha P. Curtis. Circulation 2011 ; first published on August 22 2011 as doi:10.1161/CIRCULATIONAHA.111.044107.
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction