Summary of evidence regarding hospital strategies to reduce door-to-balloon times for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Elizabeth H. Bradley, Brahmajee K. Nallamothu, Jeptha P. Curtis, Tashonna R. Webster, David J. Magid, Christopher B. Granger, Mauro Moscucci, Harlan M. Krumholz

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Despite the clinical importance of prompt percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction, many hospitals do not routinely achieve the guideline-recommended 90-minute door-to-balloon times. In this review, we evaluate existing evidence that identifies effective hospital strategies for reducing door-to-balloon time.We performed a computerized search of MEDLINE and Current Contents for studies conducted in the last 10 years of hospital efforts to improve door-to-balloon times. We excluded studies that had <10 patients, had nonspecific efforts, or, for quantitative studies, lacked statistical tests; each study was independently evaluated by 3 researchers.We found 13 studies that examined the relationship between hospital-based strategies and door-to-balloon times. Three examined national samples of hospitals using cross-sectional designs; 8 were conducted in a single or small number of hospitals using pre/post interventional or cross-sectional designs, and 2 were qualitative in design. Strategies with the strongest evidence include (1) activation of the catheterization laboratory using emergency medicine physicians rather than cardiologists, (2) effective use of prehospital electrocardiograms, (3) performance data monitoring/feedback. Reasonable evidence exists for establishing a single-call system for activating the catheterization laboratory, setting the expectation that the catheterization team be available 20-30 minutes after being paged, and having an organizational environment with strong senior management support and culture to foster changes directed at improving door-to-balloon time.In conclusion, although evidence of "what works" is based on observational studies rather than randomized trials, there is evidence on effective interventions to reduce door-to-balloon time.

Original languageEnglish
Pages (from-to)91-97
Number of pages7
JournalCritical Pathways in Cardiology
Volume6
Issue number3
DOIs
StatePublished - Sep 1 2007

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Percutaneous Coronary Intervention
Catheterization
Emergency Medicine
MEDLINE
Observational Studies
ST Elevation Myocardial Infarction
Electrocardiography
Research Personnel
Guidelines
Physicians

Keywords

  • Percutaneous coronary intervention
  • Quality improvement
  • Time to treatment

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Summary of evidence regarding hospital strategies to reduce door-to-balloon times for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. / Bradley, Elizabeth H.; Nallamothu, Brahmajee K.; Curtis, Jeptha P.; Webster, Tashonna R.; Magid, David J.; Granger, Christopher B.; Moscucci, Mauro; Krumholz, Harlan M.

In: Critical Pathways in Cardiology, Vol. 6, No. 3, 01.09.2007, p. 91-97.

Research output: Contribution to journalArticle

Bradley, Elizabeth H. ; Nallamothu, Brahmajee K. ; Curtis, Jeptha P. ; Webster, Tashonna R. ; Magid, David J. ; Granger, Christopher B. ; Moscucci, Mauro ; Krumholz, Harlan M. / Summary of evidence regarding hospital strategies to reduce door-to-balloon times for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. In: Critical Pathways in Cardiology. 2007 ; Vol. 6, No. 3. pp. 91-97.
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