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Statewide program helps improve quality of care for heart attack
Date:11/4/2007

>The study included 65 hospitals and associated emergency medical systems (10 PCI hospitals and 55 non-PCI hospitals) in five regions in North Carolina, and 1,164 patients with STEMI (579 pre-intervention, 585 post-intervention) eligible for reperfusion who were treated at PCI hospitals; and 925 patients with STEMI (518 pre-intervention, 407 post-intervention) who were treated at non-PCI hospitals. The authors examined the reperfusion times and rates three months before (July September 2005) and three months after (January March 2007) a year-long implementation.

Among patients presenting to PCI hospitals who underwent primary PCI, the proportion with first door-to-device times less than 90 minutes increased from 57 percent to 72 percent with a decrease in median (midpoint) time from 85 to 74 minutes. For patients transferred from a non-PCI hospital to another hospital for primary PCI, median time from first door-to-device declined from 165 minutes to 128 minutes. For patients presenting to the 55 non-PCI hospitals, median door-in to door-out times decreased from 120 minutes to 71 minutes. Reperfusion times also improved for door-to-needle times in non-PCI hospitals (35 to 29 minutes).

For patients treated at or transferred to PCI hospitals, clinical outcomes including death, cardiac arrest, and cardiogenic shock did not significantly change following the intervention, although the study was not designed to directly assess these outcomes.

We have demonstrated that a statewide program focused on the development of regional systems for STEMI reperfusion can significantly improve quality of care. Further research is needed to ensure that this and other programs that demonstrate improvement in application of reperfusion therapies lead to reduced mortality and morbidity from acute myocardial infarction, the authors conclude.


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Contact: Michelle Gailiun
919-724-5343
JAMA and Archives Journals
Source:Eurekalert

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