Timely treatment for acute myocardial infarction and health outcomes: an integrative review of the literature.
BACKGROUND
Coronary heart disease is the most common condition affecting Australians. The time sensitive nature of treating ST-segment elevation myocardial infarction (STEMI) has been the subject of extensive research for several years. Despite important advances in strategies to reduce time to treatment, time continues to represent a major determinant of mortality and morbidity. Door to balloon time (DTBT) is a key indicator of quality of care for STEMI. Nurses play a pivotal role in streamlining the care processes to influence timely management of STEMI.


OBJECTIVE
The aim of this paper is to review the evidence on the time to treat STEMI, the associated factors impacting upon health outcomes and explore systems of care that reduce time to treatment, using an integrative review approach.


METHODS
Established databases were searched from 2000 to 2012. The search terms 'myocardial infarction', 'emergency medicine', 'angioplasty balloon', 'time factors', 'treatment outcome', 'mortality', 'prognosis', 'female', 'age factors', and 'readmission', were used in various combinations. Research studies that addressed the aims of this paper were examined.


RESULTS
Twenty-nine papers were included in this integrative review. The literature demonstrates a strong relationship between shorter DTBT and reduced in-hospital mortality. Factors such as age, gender, time of presentation and co-morbid condition were associated with increased in-hospital mortality. There is sparse literature examining the effect timely reperfusion has on longer-term mortality and other longer-term outcomes such as readmission rates and occurrence of heart failure. Additionally, strategies that effectively reduced DTBT were identified, yet little has been reported on the impact reduced DTBT has had upon health outcomes and whether these improvements were sustained.


CONCLUSIONS
Whilst the importance of timely reperfusion is now well recognised, additional efforts to streamline the process of care and demonstrate sustained improvement for STEMI patients is required. Nurses in the areas of emergency medicine and cardiac care, play an essential role in facilitating this.
Department of Cardiology, Austin Health, Australia; LaTrobe University School of Nursing, Australia. Electronic address: lorellemartin@yahoo.com.au.
Lorelle
L
Martin
LaTrobe University School of Nursing, Australia; Department of Cardiology, Austin Health, Australia. Electronic address: Maria.Murphy@latrobe.edu.au.
Maria
M
Murphy
LaTrobe University School of Nursing, Australia; Department of Neurosurgery, Austin Health, Australia. Electronic address: A.Scanlon@latrobe.edu.au.
Andrew
A
Scanlon
Department of Cardiology, Austin Health, Australia. Electronic address: carolyn.naismith@austin.org.au.
Carolyn
C
Naismith
Department of Cardiology, Austin Health, Australia. Electronic address: clarkdavidj@hotmail.com.
David
D
Clark
Department of Cardiology, Austin Health, Australia. Electronic address: omar.farouque@austin.org.au.
Omar
O
Farouque
D064648:Critical Care Nursing; D006801:Humans; D009203:Myocardial Infarction / Q000451:nursing*; D024802:Nurse's Role; D011787:Quality of Health Care
Door to balloon time; Myocardial infarction; Percutaneous coronary intervention; Time factors