Evidence-Based Practice Strategies for Myocardial Infarction Patients

Evidence-Based Practice Strategies to Reduce the Door-to-Balloon Time in STEMI (ST-Segment Elevation Myocardial Infarction) Patients: A Needs Assessment

Adams, J., Wong, B., & Wijeysundera, H. C. (2015). Root causes for delayed hospital discharge in patients with ST-segment Myocardial Infarction (STEMI): a qualitative analysis. BMC Cardiovascular Disorders, 15, 107.

It was noted that most STEMI patients were hospitalized for more than 48 hours, although reperfusion therapy had promised greater benefits. The authors noted that there was a need to understand factors related to the individual patient, provider, and transition to outpatient care in order to understand why STEMI patients stayed longer and then reduce STEMI time delays.

de Boer, M.-J., & Zijlstra, F. (2015). STEMI time delays: a clinical perspective. The Netherlands Heart Journal, 23, 415419.

STEMI time delays reflect the quality of care or the extent of performance. This article demonstrated that there was a need to address concomitant issues that were ignored but had a significant impact on STEMI patient care outcomes. Factors such as the extent of sickness, low reduction in mortality, patient presentation during off-duty hours, treatment skills, procedures, and even cases handled in a facility could affect time delays for STEMI patients.

Hong, M. K. (2012). Recent Advances in the Treatment of ST-Segment Elevation Myocardial Infarction. Scientifica, 2012(683683), 1-13.

Although there are considerable improvements in the treatment of STEMI patients, more research needs to be carried out to advance long-term outcomes, especially in young men. Hong established that in young men, the incidences were quite unpredictable and relatively associated with many deaths. As such, further study was needed to reduce disparities among young men outcomes relative to improvements realized in age brackets and opposite gender.

Kutcher, M. A. (2015). Door-to-Balloon Time as a Process Metric for Treatment of ST-Segment Elevation Myocardial InfarctionTime to Tap Out? Journal of the American College of Cardiology Interventions, 8(15), 1975-1977.

Kutcher showed the need to attain and sustain DBT even less than 60 minutes. However, the author showed that it was imperative to understand why minimal improvement in morbidity and mortality was achieved despite the reduction of DTB. It was further shown that factors such as time of acute ischemia onset, time for vital mechanical reperfusion through PPCI, microvascular injury, and stent implantation were significant factors to explain a less significant reduction in mortality and morbidity.

McManus, D. D., Gore, J., Yarzebski, J., Spencer, F., Lessard, D., & Goldberg, R. J. (2011). Recent Trends in the Incidence, Treatment, and Outcomes of Patients with STEMI and NSTEMI. The America Journal of Medicine, 124(1), 40-47.

Data collection and analysis is a key aspect of improving the treatment of STEMI patients and healthcare provision in general. Nonetheless, McManus et al. established that in spite of the recent improvement in STEMI patient treatment, extremely little information is known and documented. McManus et al. noted the need to collect data on recent trends in the occurrence rates, treatment, outcomes of patients, and death rate associated with STEMI

Mercuri, M., Welsford, M., Schwalm, J.-D., Mehta, S. R., Rao-Melacini, P., Valettas, N.,& Natarajan, M. K. (2015). Providing optimal regional care for ST-segment elevation myocardial infarction: a prospective cohort study of patients in the Hamilton Niagara Haldimand Brant Local Health Integration Network. CMAJ Open, 3(1), E1-E7.

To overcome challenges associated with healthcare resource distribution and constraints, Mercuri et al. noted the need for a methodical intervention for regional STEMI treatments based on timely access to the best treatment instead of the type of reperfusion offered alone for enhanced STEMI patient outcomes.

Nishida, K., Hirota, S. K., Seto, T. B., Smith, D. C., Young, C., Muranaka, W.,& Fergusson, D. J. (2010). Quality Measure Study: Progress in Reducing the Door-to-Balloon Time in Patients with ST-segment Elevation Myocardial Infarction. Hawaii Medical Journal, 69(10), 242246.

Timeliness of reperfusion for STEMMI patient is vital for improved outcomes. Nishida et al. noted that a formalized protocol reduced door-to-balloon time. Further, they also showed that there was a need for utilizing a multidisciplinary team approach to attain improved door-to-balloon time for STEMI patients.

Powell, A., Halon, J., & Nelson, J. (2014). Rural emergency medical technician pre-hospital electrocardiogram transmission. Rural Remote Health, 14, 2690.

There is a need for swift accessibility to PCI-capable hospitals in order to improve D2B times and realize positive long-term outcome on STEMI patients. However, Powel et al. observed that the number of hospitals that could offer primary PCI in the US was extremely small (less than 25% of the hospitals were PCI-capable). The situation was even worse in the rural and reserve areas of the US.

Stowens, J. C., Sonnad, S. S., & Rosenbaum, R. A. (2015). Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 16(3).

This article showed that there was a need for paramedics to conduct a brief, early notification of STEMI via 9-1-1 dispatcher to attain prompt cardiac catheterization lab (CCL) activation in facilities to significantly reduce DTB and increase the number patients meeting less than 60 minutes set as a quality measure.

Vahedi, N., & Sepehri, M. M. (2015). Developing a Framework for Analyzing Door to Balloon. Cumhuriyet University Faculty of Science Journal (CSJ), 36(4), 982-997.

The authors showed the need to use self-organizing maps for therapy levels, feedback, and effectiveness of process identification rather than average treatment time to reduce DTB. In addition, data collection for analysis of processes was vital as an innovative approach to reducing DTB.

References

de Boer, M.-J., & Zijlstra, F. (2015). STEMI time delays: a clinical perspective. The Netherlands Heart Journal, 23, 415419.

Hong, M. K. (2012). Recent Advances in the Treatment of ST-Segment Elevation Myocardial Infarction. Scientifica, 2012(683683), 1-13.

Powell, A., Halon, J., & Nelson, J. (2014). Rural emergency medical technician pre-hospital electrocardiogram transmission. Rural Remote Health, 14, 2690.

Vahedi, N., & Sepehri, M. M. (2015). Developing a Framework for Analyzing Door to Balloon. Cumhuriyet University Faculty of Science Journal (CSJ), 36(4), 982-997.

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