Door to balloon time in patients presenting with acute ST elevation myocardial infarction and time factors influencing it; an observational study from a tertiary care teaching hospital in India

S, Vimal Krishnan; Ravi, Manoj; Abraham, Siju V; Palatty, Babu Urumese; Balakrishnan, Jayaraj Mymbilly

doi:10.1016/j.ihj.2021.02.008

Cited by 4 publications

(6 citation statements)

References 11 publications

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“…The age and gender distribution of STEMI among the participants can be compared to various studies found in the literature. It was observed that the incidence of STEMI was higher among males in comparison to females [1,[6][7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines and quality improvement initiatives have emphasized the importance of achieving DTB times within specified benchmarks, often set at 90 minutes or less from the patient's arrival at the catheterization laboratory (Cath lab) [4]. However, achieving timely reperfusion remains a challenge due to various logistical, clinical, and systemic factors [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Door-to-Balloon Time in ST-Elevation Myocardial Infarction (STEMI) Patients Undergoing Primary Angioplasty in Myocardial Infarction (PAMI): An Observational Study From a Tertiary Care Centre

Shah,

Gore,

Solapure

et al. 2024

Cureus

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Door-to-Balloon Time in ST-Elevation Myocardial Infarction (STEMI) Patients Undergoing Primary Angioplasty in Myocardial Infarction (PAMI): An Observational Study From a Tertiary Care Centre

Shah,

Gore,

Solapure

et al. 2024

Cureus

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“…For outcome measurement, ECG time, cardiologist consultation time, cardiac catheterization laboratory (cath lab) activation time, the time the patient arrived at the cath lab, and balloon inflation time were obtained. We defined DTB time as the time from ED arrival to balloon inflation, door-to-ECG time as the time from ED arrival to completion of the first ECG, the ECG-to-consultation time as the time from completion of the first ECG to consultation with a cardiologist, the consultation-to-activation time as the time from cardiologist consultation to activation of the cath lab, the activation-to-cath lab-arrival time as the time from activation of the cath lab to the patient’s arrival in the cath lab, and the cath lab-arrival-to-balloon time as the time from the patient’s arrival in the cath lab to balloon inflation ( Figure 1 ) [ 1 , 2 , 3 , 7 , 8 , 9 , 19 ]. This study was approved by the Institutional Review Board of the Ditmanson Medical Foundation Chia-Yi Christian Hospital (CYCH-IRB 2022016).…”

Section: Methodsmentioning

confidence: 99%

“…National guidelines have recommended that the target time for DTB should be less than 90 min [ 1 , 2 ]. To shorten DTB time, various studies have been conducted that explored the reasons for DTB-time delay [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Among these, the impact of off-hours or weekends on DTB-time delay represents a contentious issue [ 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Emergency Department Arrival Time on Door-to-Balloon Time in Patients with ST-Segment Elevation Myocardial Infarction Receiving Primary Percutaneous Coronary Intervention

Hsiao

Hung

Zhang

et al. 2023

JCM

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Door-to-balloon (DTB) time significantly affects the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). The effects of temporal differences in emergency department (ED) arrival time on DTB time and on different segments of DTB time remain inconclusive. Therefore, we performed a retrospective study in a tertiary hospital between January 2013 and December 2021 and investigated the relationship between a patient’s arrival time and both their DTB time and different segments of their DTB time. Of 732 STEMI patients, 327 arrived during the daytime (08:01–16:00), 268 during the evening (16:01–24:00), and 137 at night (00:01–08:00). Significantly higher odds of delay in DTB time were observed during the nighttime (adjusted odds ratio (aOR): 2.87; 95% confidence interval (CI): 1.50–5.51, p = 0.002) than during the daytime. This delay was mainly attributed to a delay in cardiac catheterization laboratory (cath lab) activation-to-arrival time (aOR: 6.25; 95% CI: 3.75–10.40, p < 0.001), particularly during the 00:00–04:00 time range. Age, sex, triage level, and whether patients arrived during the COVID-19 pandemic also had independent effects on different segments of DTB time. Further studies are required to investigate the root causes of delay in DTB time and to develop specific strategies for improvement.

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“…5 Several studies from LMICs mention the causes of delays in STEMI care. [6][7][8] A state-wide government-led prehospital initiative in India improved STEMI care by strengthening transfer of patients to percutaneous coronary intervention (PCI)-capable hospitals using the hub and spoke model. 9 Another study from India evaluated a fast-track protocol and reduced the door to thrombolysis time in patients with STEMI by 33 min.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India

Bharath

Kumar²,

Sah³

et al. 2022

BMJ Open Qual

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BackgroundST-elevation myocardial infarction (STEMI) is a highly time-sensitive and life-threatening condition. Early recognition and timely management are challenging in a busy emergency department (ED), especially in low/middle-income countries where emergency systems are often fragmented. The aim of our quality improvement (QI) project was to increase the percentage of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) with door to balloon (D2B) time of <90 min by 30% over 12 months.MethodsAs part of the first step in QI, baseline data were collected at different points in the process of care. Using process maps and fishbone analysis, delays in patient registration, ECG and communication with cardiology were identified as some bottlenecks, and change ideas were tested using plan–do–study–act cycles using point-of-care QI methodology. The majority of the change ideas focused on interventions in the ED like strengthening triage, training frontline staff, early diagnosis and quick transportation of patients.ResultsDuring the baseline phase, 22.22% of patients were found to have a D2B time of <90 min. We achieved an increase of 47.78% in patients receiving PCI within 90 min and hence increased to 70% at the end of the intervention phase. Data collected for 4 months after the intervention phase were found to have sustained the effort.ConclusionSignificant improvement in the door to reperfusion time resulted from a meticulous assessment of emergency care processes by drawing process flow chart and implementation of change ideas like introduction of fast-track policy for patients with chest pain, reducing staff turnover in the triage area, formal training of staff, continuous engagement with cardiology team and by interchanging of processes which led to a reduction in time to ECG.

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Door to balloon time in patients presenting with acute ST elevation myocardial infarction and time factors influencing it; an observational study from a tertiary care teaching hospital in India

Cited by 4 publications

References 11 publications

Door-to-Balloon Time in ST-Elevation Myocardial Infarction (STEMI) Patients Undergoing Primary Angioplasty in Myocardial Infarction (PAMI): An Observational Study From a Tertiary Care Centre

Door-to-Balloon Time in ST-Elevation Myocardial Infarction (STEMI) Patients Undergoing Primary Angioplasty in Myocardial Infarction (PAMI): An Observational Study From a Tertiary Care Centre

The Impact of Emergency Department Arrival Time on Door-to-Balloon Time in Patients with ST-Segment Elevation Myocardial Infarction Receiving Primary Percutaneous Coronary Intervention

Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India

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