Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies.

Na Li,Shuduo Zhou,Mailikezhati Maimaitiming,Junxiong Ma,Yinzi Jin,Zhijie Zheng,Xuejie Dong

doi:10.3390/healthcare9111462

Na Li, Shuduo Zhou + Show 5 more

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https://doi.org/10.3390/healthcare9111462

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Abstract

(1) Background: Chest pain center accreditation has been associated with improved timelines of primary percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI). However, evidence from low- and middle-income regions was insufficient, and whether the sensitivity to improvements differs between walk-in and emergency medical service (EMS)-transported patients remained unclear. In this study, we aimed to examine the association of chest pain center accreditation status with door-to-balloon (D2B) time and the potential modification effect of arrival mode. (2) Methods: The associations were examined using generalized linear mixed models, and the effect modification of arrival mode was examined by incorporating an interaction term in the models. (3) Results: In 4186 STEMI patients, during and after accreditation were respectively associated with 65% (95% CI: 54%, 73%) and 71% (95% CI: 61%, 79%) reduced risk of D2B time being more than 90 min (using before accreditation as the reference). Decreases of 27.88 (95% CI: 19.57, 36.22) minutes and 26.55 (95% CI: 17.45, 35.70) minutes in D2B were also observed for the during and after accreditation groups, respectively. The impact of accreditation on timeline improvement was greater for EMS-transported patients than for walk-in patients. (4) Conclusions: EMS-transported patients were more sensitive to the shortened in-hospital delay associated with the initiative, which could exacerbate the existing disparity among patients with different arrival modes.

Highlights

ST-segment elevation myocardial infarction (STEMI) is the deadliest and most timesensitive acute cardiac event
A door-to-balloon time of 90 min or less is given as the Class I recommendation according to the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines [2,3]
A total of 4186 STEMI patients undergoing percutaneous coronary intervention (PCI) from 33 hospitals were enrolled in this study, including 1284 (30.7%) emergency medical service (EMS)-transported patients and 2902 (69.3%) walk-in patients

Summary

Introduction

ST-segment elevation myocardial infarction (STEMI) is the deadliest and most timesensitive acute cardiac event. The door-to-balloon time, referred to as the in-hospital delay, which denotes the interval from the patient’s arrival at the emergency department to the first inflation of an angioplasty balloon in the occluded coronary artery, is widely used to assess the timeliness of primary PCI [1]. A door-to-balloon time of 90 min or less is given as the Class I (highest level) recommendation according to the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines [2,3]. There is a very pronounced gap in the door-to-balloon time between walk-in and emergency medical service (EMS)-transported STEMI patients undergoing primary PCI [5,6,7,8]. Implementation of a healthcare quality improvement initiative, ensuring that hospitals provide timely guideline-recommended clinical practice, is warranted to reduce the in-hospital delay

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