Author + information
- Received March 9, 2012
- Revision received April 5, 2012
- Accepted April 12, 2012
- Published online August 1, 2012.
- Karl Heinrich Scholz, MD⁎,⁎ (, )
- Sebastian K.G. Maier, MD†,
- Jens Jung, MD‡,
- Claus Fleischmann, MD§,
- Gerald S. Werner, MD∥,
- Hans G. Olbrich, MD¶,
- Dorothe Ahlersmann, MD⁎,
- Friederike K. Keating, MD#,
- Claudius Jacobshagen, MD⁎⁎,#,
- Hiller Moehlis, MD∥,
- Reinhard Hilgers, MD†† and
- Lars S. Maier, MD⁎⁎
- ↵⁎Reprint requests and correspondence
: Dr. Karl Heinrich Scholz, Medizinische Klinik I, St. Bernward-Krankenhaus, 31134 Hildesheim, Germany
Objectives This study sought to evaluate the effect of systematic data analysis and standardized feedback on treatment times and outcome in a prospective multicenter trial.
Background Formalized data feedback may reduce treatment times in ST-segment elevation myocardial infarction (STEMI).
Methods Over a 15-month period, 1,183 patients presenting with STEMI were enrolled. Six primary percutaneous coronary intervention hospitals in Germany and 29 associated nonpercutaneous coronary intervention hospitals participated. Data from patient contact to balloon inflation were collected and analyzed. Pre-defined quality indicators, including the percentage of patients with pre-announced STEMI, direct handoff in the catheterization laboratory, contact-to-balloon time <90 min, door-to-balloon time <60 min, and door-to-balloon time <30 min were discussed with staff on a quarterly basis.
Results Median door-to-balloon time decreased from 71 to 58 min and contact-to-balloon time from 129 to 103 min between the first and the fifth quarter (p < 0.05 for both). Contributing were shorter stays in the emergency department, more direct handoffs from ambulances to the catheterization laboratory (from 22% to 38%, p < 0.05), and a slight increase in the number of patients transported directly to the percutaneous coronary intervention facility (primary transport). One-year mortality was reduced in the total group of patients and in the subgroup of patients with primary transport (p < 0.05). The sharpest fall in mortality was observed in patients with primary transport and TIMI (Thrombolysis In Myocardial Infarction) risk score ≥3 (n = 521) with a decrease in 30-day mortality from 23.1% to 13.3% (p < 0.05) and in 1-year mortality from 25.6% to 16.7% (p < 0.05).
Conclusions Formalized data feedback is associated with a reduction in treatment times for STEMI and with an improved prognosis, which is most pronounced in high-risk patients. (Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction [FITT-STEMI]; NCT00794001)
- myocardial infarction
- reperfusion times
- ST-segment elevation myocardial infarction systems
Supported by grants from the Deutsche Herzstiftung and the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausarzte (to Dr. Scholz). Dr. Maier is funded by the Deutsche Forschungs Gemeinschaft through a Heisenberg grant (MA 1982/4-1). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 9, 2012.
- Revision received April 5, 2012.
- Accepted April 12, 2012.
- American College of Cardiology Foundation