Factors Contributing to Door-to-Balloon Times of ≤90 Minutes in 97% of Patients with ST-Elevation Myocardial Infarction: Our One-Year Experience with a Heart Alert Protocol

Abstract

Context: Prompt percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) can significantly reduce mortality and morbidity, although its effectiveness may be limited by delays in delivery. In March 2008, our hospital implemented a Heart Alert protocol to rapidly identify and treat patients with STEMI presenting to our Emergency Department (ED) with PCI, using strategies previously described to reduce door-to-balloon times. Before the Heart Alert protocol start date, patients with STEMI presenting to our ED were treated with thrombolysis.Objective: We evaluated data from patients with STEMI after one year of use of our Heart Alert protocol to determine protocol success on the basis of the percentage of patients for whom the recommended door-to-balloon times of ≤90 minutes were met. We examined factors involved in implementation of the protocol that contributed to these results.Design: We conducted a retrospective data and chart review for patients in the ED with STEMI who underwent PCI after a Heart Alert protocol activation between March 17, 2008, and March 17, 2009.Results: During the study period, our staff met the recommended door-to-balloon time of ≤90 minutes (mean door-to-balloon time, 57.3 ± 17.6 minutes) for 70 of 72 patients (97%) presenting to our ED with STEMI. Sixty-five of the 72 patients (90.3%) survived to hospital discharge.Conclusion: Initiation of a Heart Alert protocol at our hospital resulted in achievement of door-to-balloon times of ≤90 minutes for 97% of patients with STEMI. This achievement was obtained through careful preparation, training, and interdepartmental collaboration and occurred despite immediate conversion from a previous thrombolytic protocol.

Door-to-balloon: Where do we lose time? Single centre experience in India

“…However, the longest time delay in this study was the time spent in the emergency department. 14 We, at our institute have implemented various strategies and protocols for minimizing DTB time (Table 2). We believe this is especially important in Indian perspective where the time from pain onset to hospital may be longer.…”

Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System

“…It is possible that some walk-in patients were asymptomatic upon arrival or displayed atypical symptoms thereby delaying the time to ECG and effective identification, relative to the paramedic initiated referral group who would have bypassed this triage process and had an ECG done in the field. Studies suggest that careful training of the emergency medicine physician, cardiology physicians and staff prior to implementation of a PCI centre can assist with effectively identify patients requiring PCI and thereby improve door to balloon times [ 33 , 34 ]. More recently, patient demographics and procedural variations between hospitals have been shown to delay the triage process and contribute to longer door to balloon times [ 33 , 35 ].…”

Changing Practice

“…The existing clinical implementation literature focuses on time-sensitive interventions, such as acute management of sepsis with early fluid management, central venous access, and intravenous antibiotics 7, 8 , decreasing door-to-balloon time in ST-elevation myocardial infarction 9 , and rapid initiation of therapeutic hypothermia for out-of-hospital ventricular fibrillation arrest 10 . The goal of these interventions is to improve outcomes in patients with life-threatening medical conditions; left unchecked, these afflictions would result in significant morbidity or mortality 11 .…”