Improvements in Door-to-Balloon Time in the United States, 2005 to 2010

Abstract

Background Registry studies have suggested improvements in door-to-balloon times, but a national assessment of the trends in door-to-balloon times is lacking. Moreover, we do not know if improvements in door-to-balloon times were shared equally among patient and hospital groups. Methods and Results This analysis includes all patients reported by hospitals to the Centers for Medicare & Medicaid Services for inclusion in the time to percutaneous coronary intervention acute myocardial infarction-8 (AMI-8) inpatient measure from January 1, 2005 through September 30, 2010. For each calendar year, we summarized the characteristics of patients reported for the measure including the number and percentage in each group as well as the median time to primary percutaneous coronary intervention, and the percentage with time to primary percutaneous coronary intervention within 75 minutes and within 90 minutes. Door-to-balloon time declined from a median of 96 minutes in the year ending December 31, 2005 to a median of 64 minutes in the three quarters ending September 30, 2010. There were corresponding increases in the percentage of patients who had times <90 minutes (44.2% to 91.4%) and <75 minutes (27.3% to 70.4%). The declines in median times were greatest among groups that had the highest median times during the first period: Patients >75 years of age (median decline 38 minutes); women (35 minutes); and African Americans (42 minutes). Conclusion National progress has been achieved in the treatment of patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention.

Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

“…Although the time targets used in our trial may appear daunting, the history of intervention for acute coronary syndromes suggests that such efficiency in workflow is widely attainable. 35,39,40 In conclusion, the ESCAPE trial, in which fast and efficient workflow, innovative imaging, and effective thrombectomy devices were used, provides evidence of the benefit of endovascular treatment in patients with moderate-to-severe ischemic stroke.…”

Legal and Policy Interventions to Improve Patient Safety

“…One of the most widely cited examples is the substantial improvement in door-to-balloon times seen nationally after CMS began public reporting them. 25 Considered as a whole, however, the evidence demonstrating a causal relationship between public reporting and performance improvement remains thin.…”

Advancing Cardiovascular Research

“…30 After implementation research identifi ed successful approaches to reducing door-to-balloon times, national door-to-balloon times dramatically improved. 31 On the other hand, after the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) 32 and Occluded Artery Trial (OAT) 33 fi ndings were published, physicians did not materially change their practice. 34,35 With the advent of the newly created PatientCentered Outcomes Research Institute (PCORI), 36 there is increasing focus on engaging stakeholders in prioritizing, designing, implementing, and disseminating comparative effectiveness research.…”