Comparing the Timeliness of Treatment in Younger vs. Older Patients with ST-Segment Elevation Myocardial Infarction: A Multi-Center Cohort Study

Bloos, Sean M; Kaur, Karampreet; Lang, Kendrick J.; Gavin, Nicholas; Mills, Angela M.; Baugh, Christopher W.; Patterson, Brian W.; Podolsky, S.R.; Salazar, Gilberto; Mumma, Bryn E.; Tanski, Mary; Hadley, Kelsea; Roumie, Christianne L.; McNaughton, Candace D.; Yiadom, Maame Yaa A. B.

doi:10.1016/j.jemermed.2021.01.031

Cited by 7 publications

(14 citation statements)

References 60 publications

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“…According to the literature, the recommended ECG-to-cath-lab time should be less than 45 minutes. 22 The ECG-to-cath-lab time in the current study was shorter than the time reported by Tungsubutra and Ngoenjan among patients in Thailand (93 minutes). 16 …”

Section: Discussioncontrasting

confidence: 58%

“…The present study showed that the mean time of the cath lab to the balloon was 72.89 ± 42.63 minutes longer than the recommended time of 15 minutes. 22 The cath-lab-to-balloon time in this study was longer compared to the study done by Zamani et al . 8 They found that the cath lab-to-balloon time was 15 minutes in both the delayed and non-delayed DTB groups.…”

Section: Discussioncontrasting

confidence: 51%

“…8 , 13 – 15 At the international level, the DTB time in Oman was also higher than in other countries including Thailand, Singapore, Japan, Nepal, Canada, Australia and the USA. 16 – 22 …”

Section: Discussionmentioning

confidence: 99%

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Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction

Al-Rumhi,

Al Sabei,

Al-Noumani

et al. 2024

Sultan Qaboos Univ Med J

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Objective: To estimate the door-to-balloon (DTB) time and determine the organisational-level factors that influence delayed DTB times among patients with ST-elevation myocardial infarction in the Sultanate of Oman. Methods: A cross-sectional retrospective study was conducted. All patients who presented to the emergency department at two public hospitals and underwent primary percutaneous interventions during the period of two years were included. Results: The sample included 426 patients. The median door-to-balloon time was 142 minutes. The result of bivariate logistic regression showed that patients who presented to the emergency department with atypical symptoms were three times more likely to have a delayed DTB time compared with patients presenting with typical symptoms (OR = 3.003, 95% CI: 1.409–6.400, p = .004). In addition, patients who presented during off-hours were two times more likely to have a delayed DTB time compared with patients who presented during regular working hours (OR = 2.291, 95% CI: 1.284–4.087, p = .005). Conclusion: To meet the door-to-balloon time recommendation, it is important to ensure that there is adequate staffing during both regular and irregular working hours. Results from this study can be used as a baseline for future studies and inform strategies for improving the quality of care. Keywords: Acute Myocardial Infarction; Clinical Management; Door-to-balloon Time; Emergency Care Systems; Staffing and Scheduling; Oman.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussioncontrasting

confidence: 51%

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Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction

Al-Rumhi,

Al Sabei,

Al-Noumani

et al. 2024

Sultan Qaboos Univ Med J

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“…We included demographic subgroups for which the literature has previously described variation in the timeliness of care [ 4 , 8 , 9 , 10 , 11 , 22 , 23 ]. These include sex (male or female), age (18–29, 30–49, 50–64, 65–80, and >80), race (Asian, Black/African American, Native American, Alaskan, or Hawaiian/Pacific Islander, White, other race, and unknown/refused), ethnicity (Hispanic or Non-Hispanic), and language (English, Spanish, or other language).…”

Section: Methodsmentioning

confidence: 99%

“…For patients, the primary outcome was a final hospital diagnosis of ACS as per methods previously published and validated, which use international classification of disease billing codes [ 22 , 24 , 25 ]. We also examined cases of STEMI to understand the impact of false negatives and effective screening capture of ACS patients for an early ECG to identify those with STEMI.…”

Section: Methodsmentioning

confidence: 99%

Maximizing Equity in Acute Coronary Syndrome Screening across Sociodemographic Characteristics of Patients

et al. 2023

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We compared four methods to screen emergency department (ED) patients for an early electrocardiogram (ECG) to diagnose ST-elevation myocardial infarction (STEMI) in a 5-year retrospective cohort through observed practice, objective application of screening protocol criteria, a predictive model, and a model augmenting human practice. We measured screening performance by sensitivity, missed acute coronary syndrome (ACS) and STEMI, and the number of ECGs required. Our cohort of 279,132 ED visits included 1397 patients who had a diagnosis of ACS. We found that screening by observed practice augmented with the model delivered the highest sensitivity for detecting ACS (92.9%, 95%CI: 91.4–94.2%) and showed little variation across sex, race, ethnicity, language, and age, demonstrating equity. Although it missed a few cases of ACS (7.6%) and STEMI (4.4%), it did require ECGs on an additional 11.1% of patients compared to current practice. Screening by protocol performed the worst, underdiagnosing young, Black, Native American, Alaskan or Hawaiian/Pacific Islander, and Hispanic patients. Thus, adding a predictive model to augment human practice improved the detection of ACS and STEMI and did so most equitably across the groups. Hence, combining human and model screening––rather than relying on either alone––may maximize ACS screening performance and equity.

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Influence of time‐to‐diagnosis on time‐to‐percutaneous coronary intervention for emergency department ST‐elevation myocardial infarction patients: Time‐to‐electrocardiogram matters

Yiadom,

Gong,

Patterson

et al. 2024

JACEP Open

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ObjectivesEarlier electrocardiogram (ECG) acquisition for ST‐elevation myocardial infarction (STEMI) is associated with earlier percutaneous coronary intervention (PCI) and better patient outcomes. However, the exact relationship between timely ECG and timely PCI is unclear.MethodsWe quantified the influence of door‐to‐ECG (D2E) time on ECG‐to‐PCI balloon (E2B) intervention in this three‐year retrospective cohort study, including patients from 10 geographically diverse emergency departments (EDs) co‐located with a PCI center. The study included 576 STEMI patients excluding those with a screening ECG before ED arrival or non‐diagnostic initial ED ECG. We used a linear mixed‐effects model to evaluate D2E's influence on E2B with piecewise linear terms for D2E times associated with time intervals designated as ED intake (0–10 min), triage (11–30 min), and main ED (>30 min). We adjusted for demographic and visit characteristics, past medical history, and included ED location as a random effect.ResultsThe median E2B interval was longer (76 vs 68 min, p < 0.001) in patients with D2E >10 min than in those with timely D2E. The proportion of patients identified at the intake, triage, and main ED intervals was 65.8%, 24.9%, and 9.7%, respectively. The D2E and E2B association was statistically significant in the triage phase, where a 1‐minute change in D2E was associated with a 1.24‐minute change in E2B (95% confidence interval [CI]: 0.44–2.05, p = 0.003).ConclusionReducing D2E is associated with a shorter E2B. Targeting D2E reduction in patients currently diagnosed during triage (11–30 min) may be the greatest opportunity to improve D2B and could enable 24.9% more ED STEMI patients to achieve timely D2E.

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Comparing the Timeliness of Treatment in Younger vs. Older Patients with ST-Segment Elevation Myocardial Infarction: A Multi-Center Cohort Study

Cited by 7 publications

References 60 publications

Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction

Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction

Maximizing Equity in Acute Coronary Syndrome Screening across Sociodemographic Characteristics of Patients

Influence of time‐to‐diagnosis on time‐to‐percutaneous coronary intervention for emergency department ST‐elevation myocardial infarction patients: Time‐to‐electrocardiogram matters

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