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VARIABILITY OF DOOR-TO-DEVICE TIMES IN PATIENTS PRESENTING WITH ST-ELEVATION MYOCARDIAL INFARCTION AT A RURAL TERTIARY CARE CENTER
A155 JACC April 1, 2014 Volume 63, Issue 12
Acute Coronary Syndromes Variability of Door-to-Device Times in Patients Presenting with ST-Elevation Myocardial Infarction at a Rural Tertiary Care Center Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Acute Coronary Syndromes: STEMI Abstract Category: 1. Acute Coronary Syndromes: Clinical Presentation Number: 1190-240 Authors: Victor Abrich, Roxann Rokey, Satya Bhupathi, Juan Mesa, Marshfield Clinic - St. Joseph’s Hospital, Marshfield, WI, USA Background: Target door-to-device (DTD) time for ST-elevation myocardial infarction (STEMI) patients has been 90 minutes, with no distinction between urban and rural hospitals. Rural hospitals have been reported to have longer DTD times for transferred patients and after-hours. The aim of the study was to determine whether DTD times at our rural tertiary care center were impacted by arrival method and arrival time period. Methods: We studied 412 patients presenting with STEMI after initiation of our Rescue One program for rapid triage and transfer from 10/200612/2012. They were separated by arrival method (Emergency Room (ER), Urgent Care (UC), Field, Transfers) and arrival time (ON = Monday-Friday, 8 AM-5 PM; OFF = after-hours, weekends, holidays). Median DTD times and proportions < 90 minutes were compared. Results: Median DTD time for all groups was 85 minutes and 30-day mortality was 5.3%. Median DTD time for ER patients was 67 minutes (n=164), Transfers 95 minutes (n=204), UC 68 minutes (n=22) and Field 86 minutes (n=22). ER had highest proportion of patients achieving goal DTD time (81%) compared to Transfers (42%). Patients arriving by ER during OFF hours had a median DTD time 28 minutes longer than during ON hours with 21% fewer patients achieving goal DTD time, attributed to the time required to call in the catheterization team. Transfer patients (58%) had door-in-door-out (DIDO) times > 30 minutes. Conclusion: Our data confirm that in a rural facility such as ours, transferred patients and ER patients arriving after hours have longer DTD times. Our 30-day mortality was comparable to other rural facilities. As a result of these findings, there has been marked improvement in our DTD times in the last 2 years, with ER patients at 100% goal. We now recommend fibrinolytic therapy for STEMI patients at referring hospitals with routinely prolonged DIDO times.
Acute Coronary Syndromes Variability of Door-to-Device Times in Patients Presenting with ST-Elevation Myocardial Infarction at a Rural Tertiary Care Center Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Acute Coronary Syndromes: STEMI Abstract Category: 1. Acute Coronary Syndromes: Clinical Presentation Number: 1190-240 Authors: Victor Abrich, Roxann Rokey, Satya Bhupathi, Juan Mesa, Marshfield Clinic - St. Joseph’s Hospital, Marshfield, WI, USA Background: Target door-to-device (DTD) time for ST-elevation myocardial infarction (STEMI) patients has been 90 minutes, with no distinction between urban and rural hospitals. Rural hospitals have been reported to have longer DTD times for transferred patients and after-hours. The aim of the study was to determine whether DTD times at our rural tertiary care center were impacted by arrival method and arrival time period. Methods: We studied 412 patients presenting with STEMI after initiation of our Rescue One program for rapid triage and transfer from 10/200612/2012. They were separated by arrival method (Emergency Room (ER), Urgent Care (UC), Field, Transfers) and arrival time (ON = Monday-Friday, 8 AM-5 PM; OFF = after-hours, weekends, holidays). Median DTD times and proportions < 90 minutes were compared. Results: Median DTD time for all groups was 85 minutes and 30-day mortality was 5.3%. Median DTD time for ER patients was 67 minutes (n=164), Transfers 95 minutes (n=204), UC 68 minutes (n=22) and Field 86 minutes (n=22). ER had highest proportion of patients achieving goal DTD time (81%) compared to Transfers (42%). Patients arriving by ER during OFF hours had a median DTD time 28 minutes longer than during ON hours with 21% fewer patients achieving goal DTD time, attributed to the time required to call in the catheterization team. Transfer patients (58%) had door-in-door-out (DIDO) times > 30 minutes. Conclusion: Our data confirm that in a rural facility such as ours, transferred patients and ER patients arriving after hours have longer DTD times. Our 30-day mortality was comparable to other rural facilities. As a result of these findings, there has been marked improvement in our DTD times in the last 2 years, with ER patients at 100% goal. We now recommend fibrinolytic therapy for STEMI patients at referring hospitals with routinely prolonged DIDO times.