title: On versus off-hour care of patients with acute coronary syndrome and persistent ST-segment elevation in certified German chest pain units.
abstract: BACKGROUND
  Regional healthcare projects improve the off-hour care of patients with acute coronary syndromes and persistent ST-segment elevation myocardial infarction (STEMI). To analyse differences in quality of care between on and off-hour care of STEMI patients admitted to certified German chest pain units.
  
  
  METHODS
  A total of 1107 STEMI patients from the German chest pain unit registry were enrolled. Analyses comprised critical time intervals (symptoms to first medical contact (FMC), FMC to admission, symptoms to admission, symptoms to balloon, FMC to balloon, door to balloon times) and major adverse cardiac and cerebrovascular events at follow-up.
  
  
  RESULTS
  54.8% of patients were admitted off-hours. Symptoms to admission (2:28 (1:28-5:20 h) vs. 3:16 h (1:35-8:06 h), P<0.001), symptoms to FMC (1:15 h (0:33-3:00 h) vs. 2:00 h (0:40-6:46 h), P<0.001) and FMC to admission intervals (0:45 h (0:30-1:20 h) vs. 0:52 h (0:32-1:35 h), P=0.09) were shorter during off-hours. Percutaneous revascularisation rates were high and without difference between on and off-hours (95.5% vs. 96.8%, P=0.30). Door to balloon times were significantly less during on-hours (0:32 h (0:18-1:06 h) vs. 0:44 h (0:23-1:20 h), P<0.01) without negative impact on the proportion of patients with a door to balloon time of <60 min (72.6% vs. 68.4%, P=0.19), symptoms to balloon (3:49 h (2:12-10:46 h) vs. 3:30 h (2:04-7:41 h), P=0.08) or FMC to balloon times (1:26 h (0:56-2:22 h) vs. 1:30 h (1:03-2:29 h), P=0.14). Major adverse cardiac and cerebrovascular event rates did not differ significantly between on and off-hours (log-rank test P=0.36).
  
  
  CONCLUSIONS
  The German chest pain unit network ensures rapid and structured preclinical and in-hospital care independent from the circadian variation of admission. Slower door to balloon times off-hours are compensated by faster symptoms to admission or symptoms to FMC intervals. Further efforts should focus on patient awareness programmes on-hours and STEMI alarming tracks off-hours.
authors.affiliation: 1 Department of Cardiology, Arnsberg Medical Center, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Breuckmann
authors.affiliation: 2 Institute for Myocardial Infarction Research, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.affiliation: 3 Cardioangiologisches Centrum Bethanien, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Voigtländer
authors.affiliation: 4 Medical Clinic I, Lukaskrankenhaus GmbH, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Haude
authors.affiliation: 5 Clinic for Cardiology and Angiology, Municipal Hospital Karlsruhe, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: 6 2nd Department of Medicine, Johannes Gutenberg-University Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: 7 3rd Department of Medicine, University Hospital Heidelberg, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: 8 Department of Cardiology, Pneumology, Internal Intensive Care Medicine, Städtisches Klinikum München GmbH, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Mudra
authors.affiliation: 9 Institute for Pathophysiology, University Duisburg-Essen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.affiliation: 10 2nd Department of Medicine, Westpfalz-Klinikum, Germany.
authors.forename: Burghard
authors.initials: B
authors.lastname: Schumacher
authors.affiliation: 11 Department of Cardiology, Herz- und Gefäß-Klinik GmbH, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Barth
authors.affiliation: 12 University of Leipzig, Heart Center, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: 13 Department of Cardiology, Catholic Clinics Essen-Northwest, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Hailer
authors.affiliation: 14 2nd Department of Medicine, HELIOS Kreiskrankenhaus Gotha/Ohrdruf, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Walther
authors.affiliation: 2 Institute for Myocardial Infarction Research, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D039602:After-Hours Care / Q000379:methods*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods / Q000706:statistics & numerical data; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D061665:Time-to-Treatment
keywords: Chest pain unit; STEMI; off-hours; percutaneous coronary intervention; time delay; working hours