KNOWLEDGE TRANSLATION TO REDUCE DELAYS OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS IN QUÉBEC - INSIGHTS FROM THE AMI ON TIME STUDY

Abstract

We previously showed prolonged delays of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation (STEMI) at 17 Québec hospitals in 2003 (median door-to-balloon (D2B) time: 102 minutes (mins)) for patients who presented directly to hospitals with on-site PCI facility (PCI-hospital). The primary objective of this study is to determine whether knowledge translation (KT) increases the adoption of AHA recommended strategies to reduce D2B time. The AMI-ONTIME study was a pre-post study evaluating the effectiveness of KT in increasing the adoption of the following strategies: (1) emergency physician (EP)’s direct activation of PCI-personnel, (2) single-number page system, (3) PCI personnel to be ready within 30 min of activation and (4) rapid feedback of D2B time. The primary endpoint was the proportion of PCI-hospitals which implemented all four strategies. We also evaluated the proportions of PCI-hospitals that accepted patients with STEMI at all times, maintain adequate volumes of PCI and dedicated personnel for quality control of primary PCI. We sent surveys to all 13 Québec PCI-hospitals in 2009 and in 2013. The response rates were 100% for both 2009 surveys. The KT interventions were networking between pre-hospital and in-hospital personnel, identification and resolution of obstacles to prompt primary PCI, use of opinion leaders, evaluation and feedback of STEMI care, hospital-based STEMI team and educational website. We also measured prospectively D2B times in patients who underwent primary PCI, without inter-hospital transfer, during 2010-2011. During the same time intervals, beside from the AMI-ON TIME study, there were several noteworthy provincial initiatives such as Ministry of Health’s mandated retrospective studies of D2B times, provincial guidelines of STEMI treatment and ongoing University of Montréal’s prospective registry of D2B times. The median D2B time was 74 mins in 2010-11 for patients who underwent primary PCI without inter-hospital transfer in Québec (68% of patients underwent primary PCI within 90 mins). Adoption rates of AHA recommended strategies are shown in the Table below. * denote statistically significant differences between values obtained before and after KT (p values <0.001) Increased adoption of AHA-recommended strategies was associated with reduction in D2B time in Québec. These improvements in STEMI care may have been partially due to KT interventions combined with the other province-wide initiatives mentioned above. However, a few strategies remained under-used such as single-number page system and rapid feedback of D2B time. Emphasis on these interventions should be made for timelier primary PCI in Québec.