Abstract 19705: Real-time Home-to-hospital Ischemic Time Dashboard in Patients With ST segment Elevation Myocardial Infarction Results in Significant Improvement of the Logistic Chain and Lower Short-term Mortality
Introduction: Timely reperfusion with primary percutaneous coronary intervention (PCI) in ST segment elevation myocardial infarction (STEMI) patients is associated with superior clinical outcomes. Aiming to reduce ischemic time, an innovative system for H2H time monitoring was implemented. The objective of this study was to assess the results of a real time home-to-hospital (H2H) dashboard for monitoring and evaluation of ischemic time in STEMI patients.
Methods: Ischemic time in STEMI patients transported by Emergency Medical Services (EMS) and treated with primary PCI in the Medical Center Alkmaar before (n=843) and after the implementation of the H2H dashboard (n=441) was compared. Time points in the H2H dashboard were semi-automatically registered, enabling evaluation by the EMS and Cardiology departments. Before implementation of the H2H dashboard, time points were recorded on paper and retrospectively collected.
Results: Median treatment delay, first medical contact (FMC) to balloon time and door-to-balloon time were significantly shorter in the H2H group (treatment delay 142 minutes [IQR 103;221 minutes] vs. 181 minutes [IQR 134;286 minutes] P value <0.001, FMC-to-balloon time 62 minutes [IQR 52;75 minutes] vs. 86 minutes [IQR 71;111 minutes] P value <0.001 and door-to-balloon time 32 minutes [IQR 25;43 minutes] vs. 52 minutes [IQR 34;76 minutes] P value <0.001). Adjusted for baseline characteristics, the H2H time monitoring dashboard was independently associated with shorter time delays. 90-Days survival rates were significantly higher in the H2H group, this was due to lower incidence of cardiogenic shock.
Conclusions: After implementation of the H2H dashboard, significantly shorter ischemic time was observed. The use of the H2H dashboard was independently associated with shorter time delays. Short-term mortality was significantly lower in the H2H group due to lower incidence of cardiogenic shock.
- Myocardial infarction, STEMI
- Percutaneous coronary intervention (PCI)
- Emergency medical services (EMS)
Author Disclosures: M. Hermans: None. M. Velders: None. M. Smeekes: None. O. Drexhage: None. T. Ytsma: None. M. Schalij: None. V. Umans: None.
- © 2015 by American Heart Association, Inc.