Cardiology Medical News about door-to-balloon time, acute myocardial infarction, Get With the Guidelines, outcomes

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The dissociation between door-to-balloon time improvement and improvements in other acute myocardial infarction care processes and patient outcomes
Archives of Internal Medicine, 08/13/09

Wang TY et al. – Within the Get With the Guidelines (GWTG) program, findings for acute myocardial infarction (AMI) pts showed significant decreases over time for door-to-balloon (DTB) times but minimal correlation between DTB time improvement and changes in other quality measures or mortality. These results emphasize the important need for comprehensive acute myocardial infarction quality-improvement efforts vs a focus on single process measures.

Methods

Study of 101 hospitals (43,678 AMI pts) in the GWTG program
Assessment of composite for Centers for Medicare and Medicaid Services/Joint Commission on Accreditation of Healthcare Organizations (CMS/JCAHO)
Correlation for each hospital for DTB time improvement from 2005-2007 with changes in composite CMS/JCAHO core measure performance and in-hospital mortality

Results

Between 2005-2007, hospital geometric mean DTB time decreased from 101 to 87 minutes
Mean overall hospital composite CMS/JCAHO core measure performance increased from 93.4% to 96.4% for early and late periods, respectively
Mean mortality rates: 5.1% and 4.7% for early and late periods, respectively
Improvement in hospital DTB time did not significantly correlated with changes in composite quality performance or with in-hospital mortality
After adjustment for pt mix, hospitals with most improvement in DTB time did not have significantly greater improvements in either CMS/JCAHO measure performance or mortality

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