Reduction in treatment times through formalized data feedback: results from a prospective multicenter study of ST-segment elevation myocardial infarction.
OBJECTIVE
This study sought to evaluate the effect of systematic data analysis and standardized feedback on treatment times and outcome in a prospective multicenter trial.


BACKGROUND
Formalized data feedback may reduce treatment times in ST-segment elevation myocardial infarction (STEMI).


METHODS
Over a 15-month period, 1,183 patients presenting with STEMI were enrolled. Six primary percutaneous coronary intervention hospitals in Germany and 29 associated nonpercutaneous coronary intervention hospitals participated. Data from patient contact to balloon inflation were collected and analyzed. Pre-defined quality indicators, including the percentage of patients with pre-announced STEMI, direct handoff in the catheterization laboratory, contact-to-balloon time <90 min, door-to-balloon time <60 min, and door-to-balloon time <30 min were discussed with staff on a quarterly basis.


RESULTS
Median door-to-balloon time decreased from 71 to 58 min and contact-to-balloon time from 129 to 103 min between the first and the fifth quarter (p < 0.05 for both). Contributing were shorter stays in the emergency department, more direct handoffs from ambulances to the catheterization laboratory (from 22% to 38%, p < 0.05), and a slight increase in the number of patients transported directly to the percutaneous coronary intervention facility (primary transport). One-year mortality was reduced in the total group of patients and in the subgroup of patients with primary transport (p < 0.05). The sharpest fall in mortality was observed in patients with primary transport and TIMI (Thrombolysis In Myocardial Infarction) risk score ≥ 3 (n = 521) with a decrease in 30-day mortality from 23.1% to 13.3% (p < 0.05) and in 1-year mortality from 25.6% to 16.7% (p < 0.05).


CONCLUSIONS
Formalized data feedback is associated with a reduction in treatment times for STEMI and with an improved prognosis, which is most pronounced in high-risk patients. (Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction [FITT-STEMI]; NCT00794001).
Department of Cardiology, St. Bernward-Hospital, Hildesheim, Germany. prof.dr.k.scholz@bernward-khs.de
Karl Heinrich
KH
Scholz
Sebastian K G
SK
Maier
Jens
J
Jung
Claus
C
Fleischmann
Gerald S
GS
Werner
Hans G
HG
Olbrich
Dorothe
D
Ahlersmann
Friederike K
FK
Keating
Claudius
C
Jacobshagen
Hiller
H
Moehlis
Reinhard
R
Hilgers
Lars S
LS
Maier
D005246:Feedback; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies; D011996:Records; D013223:Statistics as Topic; D061665:Time-to-Treatment / Q000706:statistics & numerical data*