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Strategies for reducing the door-to-balloon time in acute myocardial infarction.
N Engl J Med. 2006 Nov 30; 355(22):2308-20.NEJM

Abstract

BACKGROUND

Prompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, few hospitals meet this objective. We sought to identify hospital strategies that were significantly associated with a faster door-to-balloon time.

METHODS

We surveyed 365 hospitals to determine whether each of 28 specific strategies was in use. We used hierarchical generalized linear models and data on patients from the Centers for Medicare and Medicaid Services to determine the association between hospital strategies and the door-to-balloon time.

RESULTS

In multivariate analysis, six strategies were significantly associated with a faster door-to-balloon time. These strategies included having emergency medicine physicians activate the catheterization laboratory (mean reduction in door-to-balloon time, 8.2 minutes), having a single call to a central page operator activate the laboratory (13.8 minutes), having the emergency department activate the catheterization laboratory while the patient is en route to the hospital (15.4 minutes), expecting staff to arrive in the catheterization laboratory within 20 minutes after being paged (vs. >30 minutes) (19.3 minutes), having an attending cardiologist always on site (14.6 minutes), and having staff in the emergency department and the catheterization laboratory use real-time data feedback (8.6 minutes). Despite the effectiveness of these strategies, only a minority of hospitals surveyed were using them.

CONCLUSIONS

Several specific hospital strategies are associated with a significant reduction in the door-to-balloon time in the management of myocardial infarction with ST-segment elevation.

Authors+Show Affiliations

Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17101617

Citation

Bradley, Elizabeth H., et al. "Strategies for Reducing the Door-to-balloon Time in Acute Myocardial Infarction." The New England Journal of Medicine, vol. 355, no. 22, 2006, pp. 2308-20.
Bradley EH, Herrin J, Wang Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med. 2006;355(22):2308-20.
Bradley, E. H., Herrin, J., Wang, Y., Barton, B. A., Webster, T. R., Mattera, J. A., Roumanis, S. A., Curtis, J. P., Nallamothu, B. K., Magid, D. J., McNamara, R. L., Parkosewich, J., Loeb, J. M., & Krumholz, H. M. (2006). Strategies for reducing the door-to-balloon time in acute myocardial infarction. The New England Journal of Medicine, 355(22), 2308-20.
Bradley EH, et al. Strategies for Reducing the Door-to-balloon Time in Acute Myocardial Infarction. N Engl J Med. 2006 Nov 30;355(22):2308-20. PubMed PMID: 17101617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Strategies for reducing the door-to-balloon time in acute myocardial infarction. AU - Bradley,Elizabeth H, AU - Herrin,Jeph, AU - Wang,Yongfei, AU - Barton,Barbara A, AU - Webster,Tashonna R, AU - Mattera,Jennifer A, AU - Roumanis,Sarah A, AU - Curtis,Jeptha P, AU - Nallamothu,Brahmajee K, AU - Magid,David J, AU - McNamara,Robert L, AU - Parkosewich,Janet, AU - Loeb,Jerod M, AU - Krumholz,Harlan M, Y1 - 2006/11/13/ PY - 2006/11/15/pubmed PY - 2006/12/9/medline PY - 2006/11/15/entrez SP - 2308 EP - 20 JF - The New England journal of medicine JO - N Engl J Med VL - 355 IS - 22 N2 - BACKGROUND: Prompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, few hospitals meet this objective. We sought to identify hospital strategies that were significantly associated with a faster door-to-balloon time. METHODS: We surveyed 365 hospitals to determine whether each of 28 specific strategies was in use. We used hierarchical generalized linear models and data on patients from the Centers for Medicare and Medicaid Services to determine the association between hospital strategies and the door-to-balloon time. RESULTS: In multivariate analysis, six strategies were significantly associated with a faster door-to-balloon time. These strategies included having emergency medicine physicians activate the catheterization laboratory (mean reduction in door-to-balloon time, 8.2 minutes), having a single call to a central page operator activate the laboratory (13.8 minutes), having the emergency department activate the catheterization laboratory while the patient is en route to the hospital (15.4 minutes), expecting staff to arrive in the catheterization laboratory within 20 minutes after being paged (vs. >30 minutes) (19.3 minutes), having an attending cardiologist always on site (14.6 minutes), and having staff in the emergency department and the catheterization laboratory use real-time data feedback (8.6 minutes). Despite the effectiveness of these strategies, only a minority of hospitals surveyed were using them. CONCLUSIONS: Several specific hospital strategies are associated with a significant reduction in the door-to-balloon time in the management of myocardial infarction with ST-segment elevation. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/17101617/Strategies_for_reducing_the_door_to_balloon_time_in_acute_myocardial_infarction_ L2 - https://www.nejm.org/doi/10.1056/NEJMsa063117?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -