Retrospective Non-Randomised Study of STEMI Management Pre and Post Participation in the Victorian Cardiac Outcome Registry

Abstract

Introduction: This is a retrospective, non-randomised study to evaluate improvement in quality of care due to participation in the Victorian Cardiac Outcome Registry (VCOR) at Mulgrave Private Hospital, Victoria. We compared data from all STEMI presentations in 2015 (pre VCOR) and 2018 (during VCOR). International guidelines benchmark 90 minutes for best practice door-to-balloontime (DTBT). Results: Close auditing of each interval was initiated during the 2018 VCOR era. Average door to cathlab time was +9.1 min (2015) and −8.2 min (2018), with the negative value denoting lab activation prior to arrival. For Ambulance Victoria pre-hospital notification patients, the comparison was 21.5 min (2015) and 14.6 min (2018). Average Door to cathlab activation also improved by 8 minutes (2015: 20.3 min; 2018: 12.5 min). Mean DTBT was longer in 2018 (106 mins) compared to 2015 (73.5 mins) but can be attributed to clinical complexity. Median DTBT was improved by 7 minutes (59 mins). Door to triage time also improved (2015: 9.75 mins; 2018: <2 mins). Conclusion: Closer auditing as a direct involvement with VCOR can identify where resources are required to achieve a DTBT <90 minutes. Cathlab is now activated earlier and DT to triage has reduced in 2018. While achieving DTBT 75% <90 minutes in both 2015 and 2018, increased visibility during VCOR involvement points to heightened proactivity in reducing DTBT aiming for improved outcomes for STEMI patients.