Author + information
- Hayder D. Hashim,
- Atish Mathur,
- Adam Raskin,
- Subbaro Boppana,
- james maher,
- Christine Gerula and
- Marc Kalpholz
We have previously reported significant reductions in door-to-balloon (D2B) and recognition-to-reperfusion (R2R) times by use of a fully automated wireless network that transmits 12-lead ECG of patients with suspected ST elevation myocardial infarction (STEMI) from emergency medical services (EMS) personnel in the field to smartphones worn by cardiologists (STAT-MI pathway). We now report the effect of monthly multidisciplinary formalized data feedback on treatment times in STEMI patients who presented through other non-automated STEMI pathways (“walk-in” and un-networked EMS ambulances).
Prospective data on demographics, cardiac biomarkers, left ventricular ejection fraction (LVEF) and all-cause mortality was collected in 147 who presented through non STAT-MI pathway (“walk-in” and un-networked EMS) between June 2006 to May 2013. D2B, R2R, Total ischemic (TI), door-to-first ECG (D2ECG) and door-to-cardiac catheterization laboratory (D2LAB) times were discussed during monthly multidisciplinary meetings at our institution using a formalized date feedback spread sheets. Total study period was 84 months and data was analyzed by quarters.
Between the 1st and 4th quarters median D2B time decreased significantly from 130 to 78.5 minutes (p<0.0001); the median D2ECG time decreased from 25 to 9.5 minutes (p=0.02) and median D2LAB time decreased from 101 to 41.5 minutes (p<0.0001). Post STEMI LVEF increased from 35 ± 12 % to 53 ± 14 % (p=0.009) between 1st and 4th quarters. ECG Selvester score for estimating infarct size decreased from 10.82 ± 4.8 to 5.06 ± 4.5 (p < 0.001).
The survival trend analysis showed improvement in survival rates from 0.70 to 0.90 (p=0.04). Based on cox proportional hazards model the D2B time (HR1.006, p = 0.002), peak troponin (HR 1.004, p = 0.04), hypertension (HR 5.75, p = 0.02) and age (HR 1.04, p = 0.01) were strong independent predictors of mortality.
Monthly formalized data feedback and detailed multidisciplinary analysis of all STEMI presenters at our institution had resulted in significant reduction in treatment times and improved outcomes. A Halo effect that extended from our previously reported STAT-MI pathway.