Abstract 3173: Have Door-to-Balloon Times Improved After Initiation of the D2B Alliance? An Analysis of the Get-with-the-Guidelines Registry
In an effort to improve DTB times, the D2B Alliance enrolled ~900 PCI hospitals across the U.S. in a large quality improvement initiative. We compared changes in DTB times for hospitals in the GWTG Registry that enrolled in the D2B Alliance with those that did not. We used data on DTB times from Jul 06 to Mar 08 to allow for 1 quarter of baseline data prior to the D2B Alliance launch and 1 year of follow-up data. We limited our analysis to STEMI patients undergoing primary PCI and excluded transfer-in cases. DTB times were defined from hospital arrival to first device. We evaluated the % of patients treated within 90 minutes using GEE models to examine trends over time, with interaction terms added to assess the specific effect of the D2B Alliance. 5801 patients at 167 hospitals - 98 in the D2B Alliance and 69 that were not - were included. No significant differences were noted in age, gender, race, prior CAD and rates of compliance with composite AMI performance measures between patients at D2B Alliance and non-D2B Alliance hospitals; however, more D2B Alliance hospitals had on-site cardiac surgery (89% vs. 74%). At baseline 54.6% and 53.1% of patients at D2B Alliance and non-D2B Alliance hospitals were treated within 90 minutes, respectively; these numbers increased to 75.3% and 71.6% (both p<0.001) by the end of the study period (Figure⇓). However, no significant differences were noted in rate of change between D2B Alliance and non-D2B Alliance hospitals. The proportion of STEMI patients treated within 90 minutes improved since initiation of the D2B Alliance. Among GWTG hospitals, this improvement was not limited to facilities that directly participated.