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Okahara S, Snell GI, Levvey BJ, McDonald M, D'Costa R, Opdam H, Pilcher DV. A prediction model to determine the untapped lung donor pool outside of the DonateLife network in Victoria. Anaesth Intensive Care 2022; 50:380-387. [PMID: 35722788 DOI: 10.1177/0310057x211070011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lung transplantation is limited by a lack of suitable lung donors. In Australia, the national donation organisation (DonateLife) has taken a major role in optimising organ donor identification. However, the potential outside the DonateLife network hospitals remains uncertain. We aimed to create a prediction model for lung donation within the DonateLife network and estimate the untapped lung donors outside of the DonateLife network. We reviewed all deaths in the state of Victoria's intensive care units using a prospectively collected population-based intensive care unit database linked to organ donation records. A logistic regression model derived using patient-level data was developed to characterise the lung donors within DonateLife network hospitals. Consequently, we estimated the expected number of lung donors in Victorian hospitals outside the DonateLife network and compared the actual number. Between 2014 and 2018, 291 lung donations occurred from 8043 intensive care unit deaths in DonateLife hospitals, while only three lung donations occurred from 1373 ICU deaths in non-DonateLife hospitals. Age, sex, postoperative admission, sepsis, neurological disease, trauma, chronic respiratory disease, lung oxygenation and serum creatinine were factors independently associated with lung donation. A highly discriminatory prediction model with area under the receiver operator characteristic curve of 0.91 was developed and accurately estimated the number of lung donors. Applying the model to non-DonateLife hospital data predicted only an additional five lung donors. This prediction model revealed few additional lung donor opportunities outside the DonateLife network, and the necessity of alternative and novel strategies for lung donation. A donor prediction model could provide a useful benchmarking tool to explore organ donation potential across different jurisdictions, hospitals and transplanting centres.
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Affiliation(s)
- Shuji Okahara
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.,Lung Transplant Service, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Gregory I Snell
- Lung Transplant Service, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Bronwyn J Levvey
- Lung Transplant Service, The Alfred Hospital and Monash University, Melbourne, Australia
| | | | | | - Helen Opdam
- Organ and Tissue Authority, Canberra, Australia
| | - David V Pilcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.,Department of Intensive Care, The Alfred Hospital, Melbourne, Australia.,The Australian and New Zealand Intensive Care Society (ANZICS), Centre for Outcome and Resources Evaluation, Melbourne, Australia
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The ACIRA Registry: A Regional Tool to Improve the Healthcare Pathway for Patients Undergoing Percutaneous Coronary Interventions and Coronary Angiographies in the French Aquitaine Region: Study Design and First Results. Crit Pathw Cardiol 2021; 19:1-8. [PMID: 31567554 DOI: 10.1097/hpc.0000000000000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In France, there is a lack of information about practices and pathways of coronary angiographies and percutaneous coronary interventions (PCI). We present the design and the first results of the ACIRA registry, the goal of which is to answer questions about quality, security, appropriateness, efficiency of, and access to interventional cardiology (IC) healthcare pathway in the French Aquitaine region. METHODS The ACIRA registry is an on-going, multicenter, prospective, exhaustive, scalable, and nominative cohort study of patients who undergo coronary angiographies or percutaneous coronary intervention in any of the catheterization laboratories. The data related to hospitalizations and procedures are directly extracted from hospital information systems. In-hospital mortality, readmissions, and cardiovascular morbidity are collected from the French hospital medical information system database. An identity management system has been implemented to create the patient health care pathway. RESULTS From January 1, 2012, to June 30, 2018, 147,136 procedures performed on 106,005 patients have been included in the ACIRA registry. CONCLUSIONS ACIRA has shown its ability to study the patient IC healthcare pathway, up to 1 year after the procedure. Nominative data enable the linkage between clinical and medico-administrative databases and possible supplementary data collection. The use of existing databases allowed us to limit patients lost to follow-up, prevent the double entry of data, improve data quality, and reduce the operating costs. The prospect of linkage with the French National Health Data System may offer promising opportunities for future medical research projects and for developing collaboration and benchmarking with other IC registries abroad.
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Fang HY, Lee WC. Warning system improve the clinical outcomes in transfer patients with ST-segment elevation myocardial infarction. Medicine (Baltimore) 2021; 100:e26558. [PMID: 34190194 PMCID: PMC8257831 DOI: 10.1097/md.0000000000026558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/12/2021] [Indexed: 01/04/2023] Open
Abstract
A warning system included directly faxing electrocardiography information to the mobile phone immediately after an ST-segment elevation myocardial infarction (STEMI) diagnosis was made at a non-percutaneous coronary intervention (PCI) capable hospital. This study aimed to explore the outcomes after using a warning system in transfer STEMI patients.From October 2013 to December 2016, 667 patients experienced a STEMI event and received primary PCI at our institution. 274 patients who were divided into transfer group were transferred from non-PCI capable hospitals and connected to a first-line cardiovascular doctor by the warning system. Other 393 patients were divided into the non-transfer group.The transfer group still had a longer pain-to-reperfusion time and presented higher troponin-I level when compared with non-transfer group. There was no significant difference in the use of drug-eluting stent and procedural devices between non-transfer and transfer groups. The prevalence of different anti-platelet agents loading did not differ between non-transfer and transfer groups. Non-significant trend about higher prevalence of statin use was noted in transfer group (78.9% vs 86.1%, P = .058). The transfer group presented similar clinical short-term results regarding both cardiovascular and all-cause mortality when comparing with non-transfer group. The transfer group provided non-significant trend about lower one-year cardiovascular mortality (10.7% vs 6.2%, P = .052) and lower all-cause mortality (12.2% vs 6.9%, P = .026) when compared with non-transfer group. There was a significant difference in the Kaplan-Meier curve of 1-year cardiovascular mortality between the transfer group and the non-transfer group (P = .049).After using the warning system, the inter-facility transfer group had comparable outcomes even though a longer pain-to-reperfusion time and a higher peak troponin-I level when comparing with non-transfer group.
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Verdoia M, Viola O, D'Amico G, Ravetto C, Comoglio A, Fusco M, Giachino P, La Cognata S, Novara F, Bristot F, Pipan P, Magnaghi M, Brancati MF, Soldà PL, Marcolongo M. The FAST-STEMI Network in Biella From 2013 to 2019: Impact of the Delocalization of the Hospital Facilities on Ischemia Time and In-hospital Outcomes. Crit Pathw Cardiol 2021; 20:75-80. [PMID: 33177351 DOI: 10.1097/hpc.0000000000000248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The optimization of the strategies for myocardial revascularization has improved the outcomes of patients with ST-segment elevation myocardial infarction. In Piedmont, the FAST-STEMI regional network was created for improving the management and transportation of ST-segment elevation (STEMI) patients to primary percutaneous coronary intervention facilities, reducing the time to reperfusion. Within this network, the Hospital of Biella was delocalized in December 2014 to a new suburban structure designed for an easier access, which might have shortened the duration of patients' transportation and ischemia, with potential positive prognostic effects. The aim of the present study was to define the impact of the decentralization of the hospital structure on the time to reperfusion and in-hospital outcomes among STEMI patients admitted to the Hospital of Biella. METHODS We included STEMI patients admitted to our urban hospital between 2013 and 2019 and included in the FAST-STEMI database. The primary endpoint was the duration of ischemia, defined as pain to balloon (PTB). The primary outcome endpoint (PE) was in-hospital mortality. RESULTS We included 276 consecutive patients with STEMI undergoing primary percutaneous coronary intervention between 2016 and 2019 in the new hospital facility, which were compared with 170 patients treated between 2013 and June 2014 in the prior structure. Patients' characteristics included a mean age of 67.5 ± 12.5 years, 72.1% males and 18.7% patients with diabetes. In the new facility, the median PTB was 188 minutes [interquartile range: 125-340 min], reduced as compared with the period 2013-2014 [215 (128.5-352 min), P = 0.002]. The median in-hospital stay was also shorter (P = 0.004), whereas a nonsignificant improvement was noted for ejection fraction (EF) at discharge (P = 0.14). A linear relationship was demonstrated between PTB and the EF (r = -0.183, P = 0.003) in patients treated between 2016 and 2019 while not affecting the length of hospitalization or in-hospital outcomes. In fact, in-hospital death occurred in 36 patients, 8% in the new structure versus 7.7% in 2013-2014 [hazard ratio (HR) (95% confidence interval [CI]) = 1.20 (0.59-2.42), P = 0.62]. The independent predictors of mortality were patients' age and EF at discharge (age ≥ 75 y: adjusted HR [95% CI] = 6.75 [1.51-30.1], P = 0.01; EF: adjusted HR [95% CI] = 0.91 [0.88-0.95], P < 0.001). CONCLUSIONS The present study shows that, among the STEMI patients treated in our center, the delocalization of the hospital facilities and the optimization of the FAST-STEMI network reduced the duration of ischemia, with positive effects on left ventricular function at discharge. However, this did not translate into a significant benefit in survival, which was instead conditioned by the aging of the population.
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Affiliation(s)
- Monica Verdoia
- From the Cardiologia e Unità Coronarica, Ospedale Degli Infermi, ASL Biella, Italy
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Czapla M, Zyśko D, Quinn T, Karniej P. Complication during transportation and 30 days mortality of patients with acute coronary syndrome. BMC Cardiovasc Disord 2020; 20:19. [PMID: 31952496 PMCID: PMC6969437 DOI: 10.1186/s12872-020-01327-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Patients with acute coronary syndrome (ACS) who present to hospitals without interventional facilities frequently require transfer to another hospital equipped with a cardiac catheterization laboratory. This retrospective cohort study evaluates the association of the type of medical transport with patient outcomes. Methods A retrospective analysis of medical records of patients with ACS transported by basic (BT) and specialist transfer (ST) by emergency medical teams (EMTs). We analyzed age, gender, hemodynamic parameters, type of the emergency medical team, and complications during transport as well as patient survival to hospital admission, survival time and the 30-day mortality rate. Results Of 500 patients who underwent transfer, ST transported 368 (73.6%) and BT 132 (26.4%) patients (p < 0.001). Complications during transportation occurred in 3 (1%) in the ST group and 2 (1.5%) in and BT group. Cardiac arrest during transfer occurred in no (0%) patients in the ST group, and 2 (1.5%) in the BT group (p = 0.118). Survival to admission was recorded in all patients in the ST group and 131/132 (0.8%) patients in the BT group (p = 0.592). 40 (12%) of patients in the ST group and 13 (11%) patients in the BT group (p = 0.731) died within 30 days of transfer. Conclusions Complications during medical transport of ACS patients from hospitals without a cardiac catheter lab to hospitals equipped with such a lab were rare and their incidence was not associated with the type of transporting EMT. The type of EMT was not associated with 30-day patient mortality.
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Affiliation(s)
- Michał Czapla
- Department of Organisation and Management, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, 51-618, Wroclaw, Poland.
| | - Dorota Zyśko
- Department of Emergency Medicine, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Tom Quinn
- Faculty of Health, Social Care and Education Kingston University and St George's, University of London, London, UK
| | - Piotr Karniej
- Department of Organisation and Management, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, 51-618, Wroclaw, Poland
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Redfield C, Tlimat A, Halpern Y, Schoenfeld DW, Ullman E, Sontag DA, Nathanson LA, Horng S. Derivation and validation of a machine learning record linkage algorithm between emergency medical services and the emergency department. J Am Med Inform Assoc 2020; 27:147-153. [PMID: 31605488 DOI: 10.1093/jamia/ocz176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Linking emergency medical services (EMS) electronic patient care reports (ePCRs) to emergency department (ED) records can provide clinicians access to vital information that can alter management. It can also create rich databases for research and quality improvement. Unfortunately, previous attempts at ePCR and ED record linkage have had limited success. In this study, we use supervised machine learning to derive and validate an automated record linkage algorithm between EMS ePCRs and ED records. MATERIALS AND METHODS All consecutive ePCRs from a single EMS provider between June 2013 and June 2015 were included. A primary reviewer matched ePCRs to a list of ED patients to create a gold standard. Age, gender, last name, first name, social security number, and date of birth were extracted. Data were randomly split into 80% training and 20% test datasets. We derived missing indicators, identical indicators, edit distances, and percent differences. A multivariate logistic regression model was trained using 5-fold cross-validation, using label k-fold, L2 regularization, and class reweighting. RESULTS A total of 14 032 ePCRs were included in the study. Interrater reliability between the primary and secondary reviewer had a kappa of 0.9. The algorithm had a sensitivity of 99.4%, a positive predictive value of 99.9%, and an area under the receiver-operating characteristic curve of 0.99 in both the training and test datasets. Date-of-birth match had the highest odds ratio of 16.9, followed by last name match (10.6). Social security number match had an odds ratio of 3.8. CONCLUSIONS We were able to successfully derive and validate a record linkage algorithm from a single EMS ePCR provider to our hospital EMR.
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Affiliation(s)
- Colby Redfield
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abdulhakim Tlimat
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Yoni Halpern
- Department of Computer Science, New York University, New York, New York, USA
| | - David W Schoenfeld
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Edward Ullman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - David A Sontag
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Larry A Nathanson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Steven Horng
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Spangler D, Hermansson T, Smekal D, Blomberg H. A validation of machine learning-based risk scores in the prehospital setting. PLoS One 2019; 14:e0226518. [PMID: 31834920 PMCID: PMC6910679 DOI: 10.1371/journal.pone.0226518] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/26/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The triage of patients in prehospital care is a difficult task, and improved risk assessment tools are needed both at the dispatch center and on the ambulance to differentiate between low- and high-risk patients. This study validates a machine learning-based approach to generating risk scores based on hospital outcomes using routinely collected prehospital data. METHODS Dispatch, ambulance, and hospital data were collected in one Swedish region from 2016-2017. Dispatch center and ambulance records were used to develop gradient boosting models predicting hospital admission, critical care (defined as admission to an intensive care unit or in-hospital mortality), and two-day mortality. Composite risk scores were generated based on the models and compared to National Early Warning Scores (NEWS) and actual dispatched priorities in a prospectively gathered dataset from 2018. RESULTS A total of 38203 patients were included from 2016-2018. Concordance indexes (or areas under the receiver operating characteristics curve) for dispatched priorities ranged from 0.51-0.66, while those for NEWS ranged from 0.66-0.85. Concordance ranged from 0.70-0.79 for risk scores based only on dispatch data, and 0.79-0.89 for risk scores including ambulance data. Dispatch data-based risk scores consistently outperformed dispatched priorities in predicting hospital outcomes, while models including ambulance data also consistently outperformed NEWS. Model performance in the prospective test dataset was similar to that found using cross-validation, and calibration was comparable to that of NEWS. CONCLUSIONS Machine learning-based risk scores outperformed a widely-used rule-based triage algorithm and human prioritization decisions in predicting hospital outcomes. Performance was robust in a prospectively gathered dataset, and scores demonstrated adequate calibration. Future research should explore the robustness of these methods when applied to other settings, establish appropriate outcome measures for use in determining the need for prehospital care, and investigate the clinical impact of interventions based on these methods.
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Affiliation(s)
- Douglas Spangler
- Uppsala Center for Prehospital Research, Department of Surgical Sciences—Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Thomas Hermansson
- Uppsala Ambulance Service, Uppsala University Hospital, Uppsala, Sweden
| | - David Smekal
- Uppsala Center for Prehospital Research, Department of Surgical Sciences—Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Ambulance Service, Uppsala University Hospital, Uppsala, Sweden
| | - Hans Blomberg
- Uppsala Center for Prehospital Research, Department of Surgical Sciences—Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Ambulance Service, Uppsala University Hospital, Uppsala, Sweden
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Lipe D, Giwa A, Caputo ND, Gupta N, Addison J, Cournoyer A. Do Out-of-Hospital Cardiac Arrest Patients Have Increased Chances of Survival When Transported to a Cardiac Resuscitation Center? J Am Heart Assoc 2019; 7:e011079. [PMID: 30482128 PMCID: PMC6405559 DOI: 10.1161/jaha.118.011079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Patients suffering from an out‐of‐hospital cardiac arrest are often transported to the closest hospital. Although it has been suggested that these patients be transported to cardiac resuscitation centers, few jurisdictions have acted on this recommendation. To better evaluate the evidence on this subject, a systematic review and meta‐analysis of the currently available literature evaluating the association between the destination hospital's capability (cardiac resuscitation center or not) and resuscitation outcomes for adult patients suffering from an out‐of‐hospital cardiac arrest was performed. Methods and Results PubMed, EMBASE, and the Cochrane Library databases were first searched using a specifically designed search strategy. Both original randomized controlled trials and observational studies were considered for inclusion. Cardiac resuscitation centers were defined as having on‐site percutaneous coronary intervention and targeted temperature management capability at all times. The primary outcome measure was survival. Twelve nonrandomized observational studies were retained in this review. A total of 61 240 patients were included in the 10 studies that could be included in the meta‐analysis regarding the survival outcome. Being transported to a cardiac resuscitation center was associated with an increase in survival (odds ratio=1.95 [95% confidence interval 1.47‐2.59], P<0.001). Conclusions Adult patients suffering from an out‐of‐hospital cardiac arrest transported to cardiac resuscitation centers have better outcomes than their counterparts. When possible, it is reasonable to transport these patients directly to cardiac resuscitation centers (class IIa, level of evidence B, nonrandomized). Clinical Trial Registration URL: http://www.crd.york.ac.uk/PROSPERO/. Unique identifier: CRD42018086608.
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Affiliation(s)
- Demis Lipe
- 1 Department of Emergency Medicine MD Anderson Cancer Center Houston TX
| | - Al Giwa
- 2 Icahn School of Medicine at Mount Sinai New York NY.,3 Department of Emergency Medicine Mount Sinai Hospital New York NY
| | - Nicholas D Caputo
- 4 Department of Emergency Medicine Lincoln Medical Center New York NY
| | - Nachiketa Gupta
- 2 Icahn School of Medicine at Mount Sinai New York NY.,3 Department of Emergency Medicine Mount Sinai Hospital New York NY
| | | | - Alexis Cournoyer
- 6 Université de Montréal Montréal Québec Canada.,7 Department of Emergency Medicine Hôpital du Sacré-Cœur de Montréal Montréal Québec Canada.,8 Institut de Cardiologie de Montréal Montréal Québec Canada
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Clark SJ, Halter M, Porter A, Smith HC, Brand M, Fothergill R, Lindridge SJ, McTigue M, Snooks H. Using deterministic record linkage to link ambulance and emergency department data: is it possible without patient identifiers? A case study from the UK. Int J Popul Data Sci 2019; 4:1104. [PMID: 34095533 PMCID: PMC8142959 DOI: 10.23889/ijpds.v4i1.1104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Routine linkage of emergency ambulance records with those from the emergency department is uncommon in the UK. Our study, known as the Pre-Hospital Emergency Department Data Linking Project (PHED Data), aimed to link records of all patients conveyed by a single emergency ambulance service to thirteen emergency departments in the UK from 2012-2016. OBJECTIVES We aimed to examine the feasibility and resource requirements of collecting de-identified emergency department patient record data and, using a deterministic matching algorithm, linking it to ambulance service data. METHODS We used a learning log to record contacts and activities undertaken by the research team to achieve data linkage. We also conducted semi-structured interviews with information management/governance staff involved in the process. RESULTS We found that five steps were required for successful data linkage for each hospital trust. The total time taken to achieve linkage was a mean of 65 weeks. A total of 958,057 emergency department records were obtained and, of these, 81% were linked to a corresponding ambulance record. The match rate varied between hospital trusts (50%-94%). Staff expressed strong enthusiasm for data linkage. Barriers to successful linkage were mainly due to inconsistencies between and within acute trusts in the recording of two ambulance event identifiers (CAD and call sign). Further data cleaning was required on emergency department fields before full analysis could be conducted. Ensuring the data was not re-identifiable limited validation of the matching method. CONCLUSION We conclude that deterministic record linkage based on the combination of two event identifiers (CAD and call sign) is possible. There is an appetite for data linkage in healthcare organisations but it is a slow process. Developments in standardising the recording of emergency department data are likely to improve the quality of the resultant linked dataset. This would further increase its value for providing evidence to support improvements in health care delivery. HIGHLIGHTS Ambulance records are rarely linked to other datasets; this study looks at the feasibility and resource requirement to use deterministic matching to link ambulance and emergency department data for patients conveyed by ambulance to the emergency department.It is possible to link these data, with an average match rate of 81% across 13 emergency departments and one large ambulance trust.All trusts approached provided match-able data and there was an appetite for data linkage; however, it was a long process taking an average of 65 weeks.We conclude that deterministic matching using no patient identifiers can be used in this setting.
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Affiliation(s)
- SJ Clark
- Medical Directorate, London Ambulance Service, London. SE1 8SD
| | - M Halter
- Kingston University and St George’s, University of London, Centre for Health and Social Care Research, London SW17 0RE
| | - A Porter
- Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - HC Smith
- Department of Primary Care and Population Health, University College London, London, UK; Formally Nuffield Trust, 59 New Cavendish Street, London, UK
| | - M Brand
- Strategy Directorate, London Ambulance Service, London. SE1 8SD
| | - R Fothergill
- Clinical Audit and Research Unit, London Ambulance Service, London. SE1 0BW
- Clinical Trials Unit, Medical School, Warwick University Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London SW17 0RE
| | - SJ Lindridge
- 27 Devonshire Way, Croydon, CR0 8BU. Emergency Care Intensive Support Team, NHS Improvement, London, SE1 8UG; Formerly Medical Directorate, London Ambulance Service NHS Trust, London, SE1 8SD
| | - M McTigue
- Operations West, London Ambulance Service, London. SE1 8SD
| | - H Snooks
- Swansea University Medical School, Singleton Park, Swansea SA2 8PP
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Alrawashdeh A, Nehme Z, Williams B, Stub D. Emergency medical service delays in ST-elevation myocardial infarction: a meta-analysis. Heart 2019; 106:365-373. [PMID: 31253694 DOI: 10.1136/heartjnl-2019-315034] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/02/2019] [Accepted: 05/26/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To evaluate emergency medical services (EMS) delays and their impact on time to treatment and mortality in patients with ST-elevation myocardial infarction (STEMI). METHOD We collected data on EMS time intervals from published studies across five electronic databases. The primary EMS interval was the time in minutes between first medical contact and arrival at hospital door (FMC-to-door time). Secondary intervals were other components of EMS delay. Weighted means were measured using random-effects models. Meta-regression was used to identify factors associated with EMS delays and to assess the impact of EMS delay on the proportion of patients treated within90 min and mortality. RESULTS Two independent reviewers included 100 studies (125 343 patients) conducted in 20 countries. The weighted mean FMC-to-door time was 41 min (n=101 646; 95% CI 39 to 43, range 21-88). However, substantial heterogeneity was observed with each interval, which could be explained by region and urban classification, distance to hospital and method of ECG interpretation. In a meta-regression adjusted for door-to-balloon time, a 10 min increase in FMC-to-door time was associated with a 10.6% (95% CI 7.6% to 13.5%; p<0.001) reduction in the proportion of patients treated within 90 min. Shorter EMS delay was significantly associated with lower short-term mortality in patients receiving prehospital thrombolysis (p=0.018). CONCLUSION EMS delays account for half of the total system delay in STEMI. There is a fourfold global variation in EMS delays, which are not completely explained by differences in system characteristics. Reducing unexplained variation could yield improvements in the time to treatment and outcome of STEMI patients. PROSPERO REGISTRATION NUMBER CRD42017074118.
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Affiliation(s)
- Ahmad Alrawashdeh
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia.,Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad Nehme
- Department of Epidemiology and PreventiveMedicine, Monash University, Prahran, Victoria, Australia.,Center for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Brett Williams
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Dion Stub
- Department of Epidemiology and PreventiveMedicine, Monash University, Prahran, Victoria, Australia.,Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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11
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Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, Sørensen HT, Januel JM, von Elm E, Langan SM. La déclaration RECORD (Reporting of Studies Conducted Using Observational Routinely Collected Health Data) : directives pour la communication des études réalisées à partir de données de santé collectées en routine. CMAJ 2019; 191:E216-E230. [PMID: 30803952 PMCID: PMC6389451 DOI: 10.1503/cmaj.181309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Eric I Benchimol
- Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol) ; Département de pédiatrie (Benchimol), Université d'Ottawa ; École d'épidémiologie et de santé publique (Benchimol, Moher), Université d'Ottawa, Ottawa, Ont. ; ICES (Benchimol, Guttmann), Toronto, Ont. ; London School of Hygiene and Tropical Medicine (Smeeth, Harron, Langan), Londres, Royaume-Uni ; Department of Paediatrics (Guttmann), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto, Toronto, Ont. ; Institut de recherche de l'Hôpital d'Ottawa (Moher), Ottawa, Ont. ; Département de soins primaires et santé publique (Petersen), University College London, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Sørensen), université d'Aarhus, Aarhus, Danemark ; Management des organisations de santé (EA 7348 MOS) (Januel), Institut du Management, École des hautes études en santé publique, Rennes, France ; Chaire d'excellence en Management de la santé (Januel), Université Sorbonne Paris Cité, Paris, France ; Cochrane Suisse (von Elm), Institut universitaire de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse
| | - Liam Smeeth
- Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol) ; Département de pédiatrie (Benchimol), Université d'Ottawa ; École d'épidémiologie et de santé publique (Benchimol, Moher), Université d'Ottawa, Ottawa, Ont. ; ICES (Benchimol, Guttmann), Toronto, Ont. ; London School of Hygiene and Tropical Medicine (Smeeth, Harron, Langan), Londres, Royaume-Uni ; Department of Paediatrics (Guttmann), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto, Toronto, Ont. ; Institut de recherche de l'Hôpital d'Ottawa (Moher), Ottawa, Ont. ; Département de soins primaires et santé publique (Petersen), University College London, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Sørensen), université d'Aarhus, Aarhus, Danemark ; Management des organisations de santé (EA 7348 MOS) (Januel), Institut du Management, École des hautes études en santé publique, Rennes, France ; Chaire d'excellence en Management de la santé (Januel), Université Sorbonne Paris Cité, Paris, France ; Cochrane Suisse (von Elm), Institut universitaire de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse
| | - Astrid Guttmann
- Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol) ; Département de pédiatrie (Benchimol), Université d'Ottawa ; École d'épidémiologie et de santé publique (Benchimol, Moher), Université d'Ottawa, Ottawa, Ont. ; ICES (Benchimol, Guttmann), Toronto, Ont. ; London School of Hygiene and Tropical Medicine (Smeeth, Harron, Langan), Londres, Royaume-Uni ; Department of Paediatrics (Guttmann), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto, Toronto, Ont. ; Institut de recherche de l'Hôpital d'Ottawa (Moher), Ottawa, Ont. ; Département de soins primaires et santé publique (Petersen), University College London, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Sørensen), université d'Aarhus, Aarhus, Danemark ; Management des organisations de santé (EA 7348 MOS) (Januel), Institut du Management, École des hautes études en santé publique, Rennes, France ; Chaire d'excellence en Management de la santé (Januel), Université Sorbonne Paris Cité, Paris, France ; Cochrane Suisse (von Elm), Institut universitaire de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse
| | - Katie Harron
- Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol) ; Département de pédiatrie (Benchimol), Université d'Ottawa ; École d'épidémiologie et de santé publique (Benchimol, Moher), Université d'Ottawa, Ottawa, Ont. ; ICES (Benchimol, Guttmann), Toronto, Ont. ; London School of Hygiene and Tropical Medicine (Smeeth, Harron, Langan), Londres, Royaume-Uni ; Department of Paediatrics (Guttmann), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto, Toronto, Ont. ; Institut de recherche de l'Hôpital d'Ottawa (Moher), Ottawa, Ont. ; Département de soins primaires et santé publique (Petersen), University College London, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Sørensen), université d'Aarhus, Aarhus, Danemark ; Management des organisations de santé (EA 7348 MOS) (Januel), Institut du Management, École des hautes études en santé publique, Rennes, France ; Chaire d'excellence en Management de la santé (Januel), Université Sorbonne Paris Cité, Paris, France ; Cochrane Suisse (von Elm), Institut universitaire de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse
| | - David Moher
- Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol) ; Département de pédiatrie (Benchimol), Université d'Ottawa ; École d'épidémiologie et de santé publique (Benchimol, Moher), Université d'Ottawa, Ottawa, Ont. ; ICES (Benchimol, Guttmann), Toronto, Ont. ; London School of Hygiene and Tropical Medicine (Smeeth, Harron, Langan), Londres, Royaume-Uni ; Department of Paediatrics (Guttmann), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto, Toronto, Ont. ; Institut de recherche de l'Hôpital d'Ottawa (Moher), Ottawa, Ont. ; Département de soins primaires et santé publique (Petersen), University College London, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Sørensen), université d'Aarhus, Aarhus, Danemark ; Management des organisations de santé (EA 7348 MOS) (Januel), Institut du Management, École des hautes études en santé publique, Rennes, France ; Chaire d'excellence en Management de la santé (Januel), Université Sorbonne Paris Cité, Paris, France ; Cochrane Suisse (von Elm), Institut universitaire de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse
| | - Irene Petersen
- Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol) ; Département de pédiatrie (Benchimol), Université d'Ottawa ; École d'épidémiologie et de santé publique (Benchimol, Moher), Université d'Ottawa, Ottawa, Ont. ; ICES (Benchimol, Guttmann), Toronto, Ont. ; London School of Hygiene and Tropical Medicine (Smeeth, Harron, Langan), Londres, Royaume-Uni ; Department of Paediatrics (Guttmann), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto, Toronto, Ont. ; Institut de recherche de l'Hôpital d'Ottawa (Moher), Ottawa, Ont. ; Département de soins primaires et santé publique (Petersen), University College London, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Sørensen), université d'Aarhus, Aarhus, Danemark ; Management des organisations de santé (EA 7348 MOS) (Januel), Institut du Management, École des hautes études en santé publique, Rennes, France ; Chaire d'excellence en Management de la santé (Januel), Université Sorbonne Paris Cité, Paris, France ; Cochrane Suisse (von Elm), Institut universitaire de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse
| | - Henrik T Sørensen
- Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol) ; Département de pédiatrie (Benchimol), Université d'Ottawa ; École d'épidémiologie et de santé publique (Benchimol, Moher), Université d'Ottawa, Ottawa, Ont. ; ICES (Benchimol, Guttmann), Toronto, Ont. ; London School of Hygiene and Tropical Medicine (Smeeth, Harron, Langan), Londres, Royaume-Uni ; Department of Paediatrics (Guttmann), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto, Toronto, Ont. ; Institut de recherche de l'Hôpital d'Ottawa (Moher), Ottawa, Ont. ; Département de soins primaires et santé publique (Petersen), University College London, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Sørensen), université d'Aarhus, Aarhus, Danemark ; Management des organisations de santé (EA 7348 MOS) (Januel), Institut du Management, École des hautes études en santé publique, Rennes, France ; Chaire d'excellence en Management de la santé (Januel), Université Sorbonne Paris Cité, Paris, France ; Cochrane Suisse (von Elm), Institut universitaire de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse
| | - Jean-Marie Januel
- Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol) ; Département de pédiatrie (Benchimol), Université d'Ottawa ; École d'épidémiologie et de santé publique (Benchimol, Moher), Université d'Ottawa, Ottawa, Ont. ; ICES (Benchimol, Guttmann), Toronto, Ont. ; London School of Hygiene and Tropical Medicine (Smeeth, Harron, Langan), Londres, Royaume-Uni ; Department of Paediatrics (Guttmann), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto, Toronto, Ont. ; Institut de recherche de l'Hôpital d'Ottawa (Moher), Ottawa, Ont. ; Département de soins primaires et santé publique (Petersen), University College London, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Sørensen), université d'Aarhus, Aarhus, Danemark ; Management des organisations de santé (EA 7348 MOS) (Januel), Institut du Management, École des hautes études en santé publique, Rennes, France ; Chaire d'excellence en Management de la santé (Januel), Université Sorbonne Paris Cité, Paris, France ; Cochrane Suisse (von Elm), Institut universitaire de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse
| | - Erik von Elm
- Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol) ; Département de pédiatrie (Benchimol), Université d'Ottawa ; École d'épidémiologie et de santé publique (Benchimol, Moher), Université d'Ottawa, Ottawa, Ont. ; ICES (Benchimol, Guttmann), Toronto, Ont. ; London School of Hygiene and Tropical Medicine (Smeeth, Harron, Langan), Londres, Royaume-Uni ; Department of Paediatrics (Guttmann), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto, Toronto, Ont. ; Institut de recherche de l'Hôpital d'Ottawa (Moher), Ottawa, Ont. ; Département de soins primaires et santé publique (Petersen), University College London, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Sørensen), université d'Aarhus, Aarhus, Danemark ; Management des organisations de santé (EA 7348 MOS) (Januel), Institut du Management, École des hautes études en santé publique, Rennes, France ; Chaire d'excellence en Management de la santé (Januel), Université Sorbonne Paris Cité, Paris, France ; Cochrane Suisse (von Elm), Institut universitaire de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse
| | - Sinéad M Langan
- Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario (Benchimol) ; Département de pédiatrie (Benchimol), Université d'Ottawa ; École d'épidémiologie et de santé publique (Benchimol, Moher), Université d'Ottawa, Ottawa, Ont. ; ICES (Benchimol, Guttmann), Toronto, Ont. ; London School of Hygiene and Tropical Medicine (Smeeth, Harron, Langan), Londres, Royaume-Uni ; Department of Paediatrics (Guttmann), The Hospital for Sick Children; Institute of Health Policy, Management and Evaluation (Guttmann), University of Toronto, Toronto, Ont. ; Institut de recherche de l'Hôpital d'Ottawa (Moher), Ottawa, Ont. ; Département de soins primaires et santé publique (Petersen), University College London, Londres, Royaume-Uni ; Département d'épidémiologie clinique (Sørensen), université d'Aarhus, Aarhus, Danemark ; Management des organisations de santé (EA 7348 MOS) (Januel), Institut du Management, École des hautes études en santé publique, Rennes, France ; Chaire d'excellence en Management de la santé (Januel), Université Sorbonne Paris Cité, Paris, France ; Cochrane Suisse (von Elm), Institut universitaire de médecine sociale et préventive, Université de Lausanne, Lausanne, Suisse
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12
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Cournoyer A, Notebaert É, de Montigny L, Ross D, Cossette S, Londei-Leduc L, Iseppon M, Lamarche Y, Sokoloff C, Potter BJ, Vadeboncoeur A, Larose D, Morris J, Daoust R, Chauny JM, Piette É, Paquet J, Cavayas YA, de Champlain F, Segal E, Albert M, Guertin MC, Denault A. Impact of the direct transfer to percutaneous coronary intervention-capable hospitals on survival to hospital discharge for patients with out-of-hospital cardiac arrest. Resuscitation 2018; 125:28-33. [DOI: 10.1016/j.resuscitation.2018.01.048] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/11/2018] [Accepted: 01/29/2018] [Indexed: 01/22/2023]
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13
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Bosson N, Baruch T, French WJ, Fang A, Kaji AH, Gausche-Hill M, Rock A, Shavelle D, Thomas JL, Niemann JT. Regional "Call 911" Emergency Department Protocol to Reduce Interfacility Transfer Delay for Patients With ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.117.006898. [PMID: 29275369 PMCID: PMC5779010 DOI: 10.1161/jaha.117.006898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated the first-medical-contact-to-balloon (FMC2B) time after implementation of a "Call 911" protocol for ST-segment-elevation myocardial infarction (STEMI) interfacility transfers in a regional system. METHODS AND RESULTS This is a retrospective cohort study of consecutive patients with STEMI requiring interfacility transfer from a STEMI referring hospital, to one of 35 percutaneous coronary intervention-capable STEMI receiving centers (SRCs). The Call 911 protocol allows the referring physician to activate 911 to transport a patient with STEMI to the nearest SRC for primary percutaneous coronary intervention. Patients with interfacility transfers were identified over a 4-year period (2011-2014) from a registry to which SRCs report treatment and outcomes for all patients with STEMI transported via 911. The primary outcomes were median FMC2B time and the proportion of patients achieving the 120-minute goal. FMC2B for primary 911 transports were calculated to serve as a system reference. There were 2471 patients with STEMI transferred to SRCs by 911 transport during the study period, of whom 1942 (79%) had emergent coronary angiography and 1410 (73%) received percutaneous coronary intervention. The median age was 61 years (interquartile range [IQR] 52-71) and 73% were men. The median FMC2B time was 111 minutes (IQR 88-153) with 56% of patients meeting the 120-minute goal. The median STEMI referring hospital door-in-door-out time was 53 minutes (IQR 37-89), emergency medical services transport time was 9 minutes (IQR 7-12), and SRC door-to-balloon time was 44 minutes (IQR 32-60). For primary 911 patients (N=4827), the median FMC2B time was 81 minutes (IQR 67-97). CONCLUSIONS Using a Call 911 protocol in this regional cardiac care system, patients with STEMI requiring interfacility transfers had a median FMC2B time of 111 minutes, with 56% meeting the 120-minute goal.
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Affiliation(s)
- Nichole Bosson
- The Los Angeles County Emergency Medical Services Agency, Los Angeles, CA .,Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - William J French
- Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Amy H Kaji
- Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Marianne Gausche-Hill
- The Los Angeles County Emergency Medical Services Agency, Los Angeles, CA.,Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - David Shavelle
- The Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Joseph L Thomas
- Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - James T Niemann
- Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
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14
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Association Between Hospital Practices and Door-in-door-out Time in ST-segment Elevation Myocardial Infarction. Crit Pathw Cardiol 2017; 15:165-168. [PMID: 27846009 DOI: 10.1097/hpc.0000000000000093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current guidelines suggest a "door-in-door-out" (DIDO) time of 30 minutes or shorter for patients with ST-segment elevation myocardial infarction (STEMI) who arrive at a STEMI referral hospital and are transferred to a STEMI-receiving center for primary percutaneous coronary intervention. Experts previously identified 18 system practices as critical for reducing DIDO times. The objective of this study was to describe how frequently these critical practices are used and to determine whether their use was associated with shorter DIDO times. METHODS We surveyed 18 STEMI referral hospitals for 4 STEMI-receiving centers regarding their use of these 18 practices. The median number used was 14 practices (interquartile range 12-15). We then evaluated their association with DIDO times in all patients (n = 93) transferred from these STEMI referral hospitals to the 4 STEMI-receiving centers for primary percutaneous coronary intervention. RESULTS In univariate linear regression analyses, system-wide quality improvement programs with leaders in the emergency medical services agencies and STEMI referral hospitals were associated with shorter DIDO times (P < 0.001 for all). Overall use of system practices was not associated with DIDO times (P = 0.143). The majority (76%, 95% confidence interval: 66%-85%) of DIDO times did not meet the 30-minute goal. CONCLUSIONS These findings highlight the difficulty in achieving the 30-minute DIDO goal and the need for continued focus on strategies for reducing DIDO time, including system-wide quality improvement programs.
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15
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Potential impact of a prehospital redirection system for refractory cardiac arrest. Resuscitation 2017; 119:37-42. [DOI: 10.1016/j.resuscitation.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/28/2017] [Accepted: 08/02/2017] [Indexed: 11/22/2022]
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16
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Hermans MPJ, Velders MA, Smeekes M, Drexhage OS, Hautvast RWM, Ytsma T, Schalij MJ, Umans VAWM. Call-to-balloon time dashboard in patients with ST-segment elevation myocardial infarction results in significant improvement in the logistic chain. EUROINTERVENTION 2017; 13:e564-e571. [PMID: 27993751 DOI: 10.4244/eij-d-16-00124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Timely reperfusion with primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients is associated with superior clinical outcomes. Aiming to reduce ischaemic time, an innovative system for home-to-hospital (H2H) time monitoring was implemented, which enabled real-time evaluation of ischaemic time intervals, regular feedback and improvements in the logistic chain. The objective of this study was to assess the results after implementation of the H2H dashboard for monitoring and evaluation of ischaemic time in STEMI patients. METHODS AND RESULTS Ischaemic time in STEMI patients transported by emergency medical services (EMS) and treated with pPCI in the Noordwest Ziekenhuis, Alkmaar before (2008-2009; n=495) and after the implementation of the H2H dashboard (2011-2014; n=441) was compared. Median time intervals were significantly shorter in the H2H group (door-to-balloon time 32 [IQR 25-43] vs. 40 [IQR 28-55] minutes, p-value <0.001, FMC-to-balloon time 62 [IQR 52-75] vs. 80 [IQR 67-103] minutes, p-value <0.001, and treatment delay 142 [IQR 103-221] vs. 159 [IQR 123-253] minutes, p-value <0.001). The H2H time dashboard was independently associated with shorter time delays. CONCLUSIONS Real-time monitoring and feedback on time delay with the H2H dashboard improves the logistic chain in STEMI patients, resulting in shorter ischaemic time intervals.
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Affiliation(s)
- Maaike P J Hermans
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
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17
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Maier B, Wagner K, Behrens S, Bruch L, Busse R, Schmidt D, Schühlen H, Thieme R, Theres H. Comparing routine administrative data with registry data for assessing quality of hospital care in patients with myocardial infarction using deterministic record linkage. BMC Health Serv Res 2016; 16:605. [PMID: 27769288 PMCID: PMC5073420 DOI: 10.1186/s12913-016-1840-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/11/2016] [Indexed: 12/02/2022] Open
Abstract
Background Assessment of quality of care in patients with myocardial infarction (MI) should be based on data that effectively enable determination of quality. With the need to simplify measurement techniques, the question arises whether routine data can be used for this purpose. We therefore compared data from a German sickness fund (AOK) with data from the Berlin Myocardial Infarction Registry (BMIR). Methods We included patients hospitalised for treatment of MI in Berlin from 2009-2011. We matched 2305 patients from AOK and BMIR by using deterministic record linkage with indirect identifiers. For matched patients we compared the frequency in documentation between AOK and BMIR for quality assurance variables and calculated the kappa coefficient (KC) as a measure of agreement. Results There was almost perfect agreement in documentation between AOK and BMIR data for matched patients for: catheter laboratory (KC: 0.874), ST elevation MI (KC: 0.826), diabetes (KC: 0.818), percutaneous coronary intervention (KC: 0.860) and hospital mortality (KC: 0.952). The remaining variables compared showed moderate or less than moderate agreement (KC < 0.6), and were grouped in Category II with less frequent documentation in AOK for risk factors and aspects of patients’ history; in Category III with more frequent documentation in AOK for comorbidities; and in Category IV for medication at and after hospital discharge. Conclusions Routine data are primarily collected and defined for reimbursement purposes. Quality assurance represents merely a secondary use. This explains why only a limited number of variables showed almost perfect agreement in documentation between AOK and BMIR. If routine data are to be used for quality assessment, they must be constantly monitored and further developed for this new application. Furthermore, routine data should be complemented with registry data by well-established methods of record linkage to realistically reflect the situation – also for those quality-associated variables not collected in routine data.
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Affiliation(s)
- Birga Maier
- Berlin Myocardial Infarction Registry, Technische Universität, Berlin, Germany.
| | - Katrin Wagner
- Berlin Myocardial Infarction Registry, Technische Universität, Berlin, Germany
| | - Steffen Behrens
- Department of Cardiology, Vivantes Humboldt Klinikum, Berlin, Germany
| | - Leonhard Bruch
- Department of Cardiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universitaet, Berlin, Germany
| | - Dagmar Schmidt
- Department Hospital Affairs, AOK Nordost, Berlin, Germany
| | - Helmut Schühlen
- Department of Cardiology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Roland Thieme
- Department of Cardiology, Jüdisches Krankenhaus, Berlin, Germany
| | - Heinz Theres
- Department of Cardiology, Medical Park Humboldt Muehle, Berlin, Germany
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18
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Benchimol EI, Smeeth L, Guttmann A, Harron K, Hemkens LG, Moher D, Petersen I, Sørensen HT, von Elm E, Langan SM. [The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 115-116:33-48. [PMID: 27837958 PMCID: PMC5330542 DOI: 10.1016/j.zefq.2016.07.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 12/17/2022]
Abstract
Zunehmend werden routinemäßig gesammelte Gesundheitsdaten, die zu administrativen und klinischen Zwecken und ohne spezifische, a priori festgelegte Forschungsziele erhoben wurden, auch für die Forschung eingesetzt. Die rasche Entwicklung und Verfügbarkeit dieser Daten machten Probleme deutlich, die in den bestehenden Berichts-Leitlinien, wie dem STROBE-Statement (Strengthening the Reporting of Observational Studies in Epidemiology) nicht behandelt werden. Das RECORD-Statement (REporting of studies Conducted using Observational Routinely-collected health Data) wurde entwickelt, um diese Lücken zu schließen. RECORD ist als Erweiterung des STROBE-Statements gedacht, um Punkte abzudecken, die spezifisch sind beim Berichten von Beobachtungsstudien, die routinemäßig gesammelte Gesundheitsdaten verwenden. RECORD besteht aus einer Checkliste von 13 Punkten mit Bezug zu Titel, Abstract, Einleitung, Methoden-, Ergebnis- und Diskussionsteil von Artikeln sowie zu anderen Informationen, die in Forschungsberichten dieser Art enthalten sein sollten. Dieses Dokument enthält die Checkliste sowie Erläuterungen und weitere Erklärungen, um die Verwendung der Checkliste zu verbessern. Beispiele für ein gutes Berichten der einzelnen Punkte der RECORD-Checkliste sind ebenfalls in diesem Dokument enthalten. Dieses Dokument sowie die zugehörige Website und ein Forum (http://www.record-statement.org) werden die Umsetzung und das Verständnis von RECORD verbessern. Autoren, Redakteure von Fachzeitschriften und Peer-Reviewer können die Transparenz beim Berichten von Forschungsergebnissen erhöhen, indem sie RECORD anwenden.
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Affiliation(s)
- Eric I Benchimol
- Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Canada; Hospital for Sick Children, Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Katie Harron
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Canada, and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London (UCL), London, United Kingdom
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine, University Medical Centre Lausanne, Lausanne, Switzerland
| | - Sinéad M Langan
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Nakatsuma K, Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Yamamoto T, Suwa S, Horie M, Kimura T. Inter-Facility Transfer vs. Direct Admission of Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Circ J 2016; 80:1764-72. [PMID: 27350014 DOI: 10.1253/circj.cj-16-0204] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inter-facility transfer for primary percutaneous coronary intervention (PCI) from referring facilities to PCI centers causes a significant delay in treatment of ST-segment elevation acute myocardial infarction (STEMI) patients undergoing primary PCI. However, little is known about the clinical outcomes of STEMI patients undergoing inter-facility transfer in Japan. METHODS AND RESULTS In the CREDO-Kyoto acute myocardial infarction (AMI) registry that enrolled 5,429 consecutive AMI patients in 26 centers in Japan, the current study population consisted of 3,820 STEMI patients who underwent primary PCI within 24 h of symptom onset. We compared long-term clinical outcomes between inter-facility transfer patients and those directly admitted to PCI centers. The primary outcome measure was a composite of all-cause death or heart failure (HF) hospitalization. There were 1,725 (45.2%) inter-facility transfer patients, and 2,095 patients (54.8%) with direct admission to PCI centers. The cumulative 5-year incidence of death/HF hospitalization was significantly higher in the inter-facility transfer patients than in those with direct admission (26.9% vs. 22.2%; log-rank P<0.001). After adjusting for potential confounders, the risk for death/HF hospitalization was significantly higher (adjusted hazard ratio: 1.22, 95% confidence interval: 1.07-1.40, P<0.001) in the inter-facility transfer patients than in those directly admitted. CONCLUSIONS Inter-facility transfer was associated with significantly worse long-term clinical outcomes for patients with STEMI undergoing primary PCI. (Circ J 2016; 80: 1764-1772).
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Affiliation(s)
- Kenji Nakatsuma
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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20
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DENG FUXUE, XIA YONG, FU MICHAEL, HU YUNFENG, JIA FANG, RAHARDJO YEFFRY, DUAN YINGYI, HE LINJING, CHANG JING. Influence of heart failure on the prognosis of patients with acute myocardial infarction in southwestern China. Exp Ther Med 2016; 11:2127-2138. [PMID: 27284294 PMCID: PMC4887864 DOI: 10.3892/etm.2016.3211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/21/2015] [Indexed: 12/13/2022] Open
Abstract
The impact of heart failure (HF) on acute myocardial infarction (AMI) in patients from southwestern China remains unclear. The present study aimed to compare in-hospital cardiovascular events, mortality and clinical therapies in AMI patients with or without HF in southwestern China. In total, 591 patients with AMI hospitalized between February 2009 and December 2012 were examined; those with a history of HF were excluded. The patients were divided into four groups according to AMI type (ST-elevated or non-ST-elevated AMI) and the presence of HF during hospitalization. Clinical characteristics, in-hospital cardiovascular events, mortality, coronary angiography and treatment were compared. Clinical therapies, specifically evidence-based drug use were analyzed in patients with HF during hospitalization, including angiotensin converting enzyme inhibitors (ACEIs) and β-blockers (BBs). AMI patients with HF had a higher frequency of co-morbidities, lower left ventricular ejection fraction, longer length of hospital stay and a greater risk of in-hospital mortality compared with AMI patients without HF. AMI patients with HF were less likely to be examined by cardiac angiography or treated with reperfusion therapy or recommended medications. AMI patients with HF co-treated with ACEIs and BBs had a significantly higher survival rate (94.4 vs. 67.5%; P<0.001) compared with untreated patients or patients treated with either ACEIs or BBs alone. Logistic regression analysis revealed that HF and cardiogenic shock in patients with AMI were the strongest predictors of in-hospital mortality. AMI patients with HF were at a higher risk of adverse outcomes. Cardiac angiography and timely standard recommended medications were associated with improved clinical outcomes.
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Affiliation(s)
- FUXUE DENG
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 404100, P.R. China
| | - YONG XIA
- Heart & Lung Research Institute, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - MICHAEL FU
- Section of Cardiology, Sahlgrenska University Hospital/Östra Hospital, Gothenburg 40530, Sweden
| | - YUNFENG HU
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 404100, P.R. China
| | - FANG JIA
- Department of Internal Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, P.R. China
| | - YEFFRY RAHARDJO
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 404100, P.R. China
| | - YINGYI DUAN
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 404100, P.R. China
| | - LINJING HE
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 404100, P.R. China
| | - JING CHANG
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 404100, P.R. China
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Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, Sørensen HT, von Elm E, Langan SM. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med 2015; 12:e1001885. [PMID: 26440803 PMCID: PMC4595218 DOI: 10.1371/journal.pmed.1001885] [Citation(s) in RCA: 2862] [Impact Index Per Article: 318.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement was created to fill these gaps. RECORD was created as an extension to the STROBE statement to address reporting items specific to observational studies using routinely collected health data. RECORD consists of a checklist of 13 items related to the title, abstract, introduction, methods, results, and discussion section of articles, and other information required for inclusion in such research reports. This document contains the checklist and explanatory and elaboration information to enhance the use of the checklist. Examples of good reporting for each RECORD checklist item are also included herein. This document, as well as the accompanying website and message board (http://www.record-statement.org), will enhance the implementation and understanding of RECORD. Through implementation of RECORD, authors, journals editors, and peer reviewers can encourage transparency of research reporting.
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Affiliation(s)
- Eric I. Benchimol
- Children’s Hospital of Eastern Ontario Research Institute, Department of Pediatrics and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Hospital for Sick Children, Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Katie Harron
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Canada, and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | | | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sinéad M. Langan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Hubble MW, Johnson C, Blackwelder J, Collopy K, Houston S, Martin M, Wilkes D, Wiser J. Probability of Return of Spontaneous Circulation as a Function of Timing of Vasopressor Administration in Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2015; 19:457-63. [DOI: 10.3109/10903127.2015.1005262] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Mumma BE, Diercks DB, Danielsen B, Holmes JF. Probabilistic Linkage of Prehospital and Outcomes Data in Out-of-hospital Cardiac Arrest. PREHOSP EMERG CARE 2014; 19:358-64. [PMID: 25495119 DOI: 10.3109/10903127.2014.980474] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Lack of longitudinal patient outcome data is an important barrier in emergency medical services (EMS) research. We aimed to demonstrate the feasibility of linking prehospital data from the California EMS Information Systems (CEMSIS) database to outcomes data from the California Office of Statewide Health Planning and Development (OSHPD) database for patients with out-of-hospital cardiac arrest (OHCA). METHODS We included patients age 18 years or older who sustained nontraumatic OHCA and were included in the 2010-2011 CEMSIS databases. The CEMSIS database is a unified EMS data collection system for California. The OSHPD database is a comprehensive data collection system for patient-level inpatient and emergency department encounters in California. OHCA patients were identified in the CEMSIS database using cardiac rhythm, procedures, medications, and provider impression. Probabilistic linkage blocks were created using in-hospital death or one of the following primary or secondary diagnoses (ICD-9-CM) in the OSHPD databases: cardiac arrest (427.5), sudden death (798), ventricular tachycardia (427.1), ventricular fibrillation (427.4), and acute myocardial infarction (410.xx). Blocking variables included incident date, gender, date of birth, age, and/or destination facility. Due to the volume of cases, match thresholds were established based on clerical record review for each block individually. Match variables included incident date, destination facility, date of birth, sex, race, and ethnicity. RESULTS Of the 14,603 cases of OHCA we identified in CEMSIS, 91 (0.6%) duplicate records were excluded. Overall, 46% of the data used in the linkage algorithm were missing in CEMSIS. We linked 4,961/14,512 (34.2%) records. Linkage rates varied significantly by local EMS agency, ranging from 1.4 to 61.1% (OR for linkage 0.009-0.76; p < 0.0001). After excluding the local EMS agency with the outlying low linkage rate, we linked 4,934/12,596 (39.2%) records. CONCLUSION Probabilistic linkage of CEMSIS prehospital data with OSHPD outcomes data was severely limited by the completeness of the EMS data. States and EMS agencies should aim to overcome data limitations so that more effective linkages are possible.
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Minimizing transfer time to an ST segment elevation myocardial infarction-receiving center: a modified Delphi consensus. Crit Pathw Cardiol 2014; 13:20-4. [PMID: 24526147 DOI: 10.1097/hpc.0000000000000003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Of patients with ST segment elevation myocardial infarction (STEMI), approximately two thirds present to a hospital not capable of percutaneous coronary intervention. Transfer to a STEMI-receiving center delays time to reperfusion in patients with STEMI, but factors that affect this delay have not been well studied. We performed a 3-round modified Delphi study to identify system practices that minimize transfer time to a STEMI-receiving center. A comprehensive literature review was used to identify candidate system practices. Emergency medical services, emergency medicine, and cardiology experts were invited to participate. Consensus was defined as 80% agreement that a variable was "very important (5)" or "important (4)" with a mean score ≥ 4.25 or 80% agreement that a variable was "not important (1)" or "somewhat important (2)" with a mean score ≤ 1.75. In round 1, participants rated the candidate items and suggested additional items. Individual feedback was provided, and participants discussed items via conference calls before rating them again in round 2. In round 3, participants ranked the consensus items from rounds 1-2 from most to least important, and the mean score for each item was calculated. Of the 98 experts invited, 29 participated in round 1, 22 in round 2, and 14 in round 3. Participants identified 18 system practices that they agree are critical in minimizing transfer time to STEMI-receiving centers, with the most important being performance of a prehospital electrocardiogram and having established transfer protocols. These factors should be considered in the development of STEMI systems of care.
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Brener SJ, Brodie BR, Guerchicoff A, Witzenbichler B, Guagliumi G, Xu K, Mehran R, Stone GW. Impact of pre-procedural cardiopulmonary instability in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trial). Am J Cardiol 2014; 114:962-7. [PMID: 25118121 DOI: 10.1016/j.amjcard.2014.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/05/2014] [Accepted: 07/05/2014] [Indexed: 11/27/2022]
Abstract
Rapid reperfusion with primary percutaneous coronary intervention improves survival in patients with ST-segment elevation myocardial infarction. Preprocedural cardiopulmonary instability and adverse events (IAE) may delay reperfusion time and worsen prognosis. The aim of this study was to evaluate the relation between preprocedural cardiopulmonary IAE, door-to-balloon time (DBT), and outcomes in the Harmonizing Outcomes With Revascularization and Stents in AMI (HORIZONS-AMI) trial. Preprocedural cardiopulmonary IAE included sustained ventricular or supraventricular tachycardia or fibrillation requiring cardioversion or defibrillation, heart block or bradycardia requiring pacemaker implantation, severe hypotension requiring vasopressors or intra-aortic balloon counterpulsation, respiratory failure requiring mechanical ventilation, and cardiopulmonary resuscitation. Three-year outcomes of patients with and without IAE according to DBT were compared. Among 3,602 patients, 159 (4.4%) had ≥1 IAE. DBT did not differ significantly in patients with and without IAE; however, patients with IAE were less likely to have Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow after percutaneous coronary intervention. Mortality at 3 years was significantly higher in patients with versus those without IAE (17.0% vs 6.3%, p<0.0001), and IAE was an independent predictor of mortality, whereas DBT was not. However, a significant interaction was present such that 3-year mortality was reduced in patients with DBT<99 minutes (the median) versus ≥99 minutes to a greater extent in patients with IAE (9.9% vs 20.7%, hazard ratio 0.43, 95% confidence interval 0.16 to 1.16) compared with those without IAE (5.0% vs 7.2%, hazard ratio 0.69, 95% confidence interval 0.50 to 0.95) (p for interaction=0.004). In conclusion, IAE before PCI is an independent predictor of death and identifies a high-risk group in whom faster reperfusion may be particularly important to improve survival.
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Cannon AR, Lin L, Lytle B, Peterson ED, Cairns CB, Glickman SW. Use of prehospital 12-lead electrocardiography and treatment times among ST-elevation myocardial infarction patients with atypical symptoms. Acad Emerg Med 2014; 21:892-8. [PMID: 25155289 DOI: 10.1111/acem.12445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/22/2014] [Accepted: 04/18/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Guidelines advise that a prehospital electrocardiogram (ECG) should be obtained in any patients with chest pain, yet up to 20% of patients with ST-elevation myocardial infarction (STEMI) do not present with chest pain. The objective was to determine the association of atypical presentations in the prehospital setting on the likelihood of receiving a prehospital ECG and subsequent time to reperfusion therapy. METHODS This study used a data set that linked prehospital medical information from a statewide EMS data system with a clinical registry of treatment and outcomes data for patients with STEMI. Among 2,639 STEMI patients from 2008 to 2010, the association between non-chest pain presentations, prehospital ECG use, and reperfusion times among patients undergoing primary percutaneous coronary intervention (PCI) were examined. Inverse probability weights were used to account for observed baseline confounders. RESULTS Overall, 318 of 2,639 patients (12.1%) presented without chest pain. A prehospital ECG was obtained in 2,021 of 2,321 (87.1%) patients with chest pain compared with only 230 of 318 (72.3%) without chest pain (odds ratio [OR] = 2.24, 95% confidence interval [CI] = 1.69 to 2.98). Among patients without chest pain, those who received a prehospital ECG had significantly shorter first medical contact (FMC) to device times (30.9% < 90 minutes vs. 11.4% > 90 minutes, adjusted OR = 2.81, 95% CI = 1.29 to 6.11, p < 0.01). CONCLUSIONS Over one-quarter of STEMI patients presenting without chest pain did not receive prehospital ECGs and had significantly longer FMC to device times. Future efforts are needed to promote the use of prehospital ECGs to achieve more rapid identification of STEMI patients with atypical presentations in the prehospital setting.
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Affiliation(s)
- Austin R. Cannon
- Department of Emergency Medicine; University of North Carolina (UNC) School of Medicine; Chapel Hill NC
| | - Li Lin
- Duke Clinical Research Institute; Duke University; Durham NC
| | - Barbara Lytle
- Duke Clinical Research Institute; Duke University; Durham NC
| | | | - Charles B. Cairns
- Department of Emergency Medicine; University of North Carolina (UNC) School of Medicine; Chapel Hill NC
| | - Seth W. Glickman
- Department of Emergency Medicine; University of North Carolina (UNC) School of Medicine; Chapel Hill NC
- Duke Clinical Research Institute; Duke University; Durham NC
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Renkiewicz GK, Hubble MW, Wesley DR, Dorian PA, Losh MJ, Swain R, Taylor SE. Probability of a Shockable Presenting Rhythm as a Function of EMS Response Time. PREHOSP EMERG CARE 2014; 18:224-30. [DOI: 10.3109/10903127.2013.851308] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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