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Kolls BJ, Ehrlich ME, Monk L, Shah S, Roettig M, Iversen E, Jollis JG, Granger CB, Graffagnino C. Regionalization of stroke systems of care in the stroke belt states: The IMPROVE stroke care quality improvement program. Am Heart J 2024; 269:72-83. [PMID: 38061683 DOI: 10.1016/j.ahj.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/18/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Despite guidelines and strong evidence supporting intravenous thrombolysis and endovascular thrombectomy for acute stroke, access to these interventions remains a challenge. The objective of the IMPROVE stroke care program was to accelerate acute stroke care delivery by implementing best practices and improving the regional systems of care within comprehensive stroke networks. METHODS The IMPROVE Stroke Care program was a prospective quality improvement program based on established models used in acute coronary care. Nine hub hospitals (comprehensive stroke centers), 52 regional/community referral hospitals (spokes), and over 100 emergency medical service agencies participated. Through 6 regional meetings, 49 best practices were chosen for improvement by the participating sites. Over 2 years, progress was tracked and discussed weekly and performance reviews were disseminated quarterly. RESULTS Data were collected on 21,647 stroke code activations of which 8,502 (39.3%) activations had a final diagnosis of stroke. There were 7,226 (85.0%) ischemic strokes, and thrombolytic therapy was administered 2,814 times (38.9%). There was significant overall improvement in the proportion that received lytic therapy within 45 minutes (baseline of 44.6%-60.4%). The hubs were more frequently achieving this at baseline, but both site types improved. A total of 1,455 (17.1%) thrombectomies were included in the data of which 401 (27.6%) were transferred from a spoke. There was no clinically significant change in door-to-groin times for hub-presenting thrombectomy patients, however, significant improvement occurred for transferred cases, 46 minutes (interquartile range [IQR] 36, 115.5) at baseline to 27 minutes (IQR 10, 59). CONCLUSIONS The IMPROVE program approach was successful at improving the delivery of thrombolytic intervention across the consortium at both spoke and hub sites through collaborative efforts to operationalize guideline-based care through iterative sharing of performance and best practices for implementation. Our approach allowed identification of both opportunities for improvement and operational best practices providing guidance on how best to create a regional stroke care network and operationalize the published acute stroke care guidelines.
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Affiliation(s)
- Brad J Kolls
- Department of Neurology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC.
| | - Matthew E Ehrlich
- Department of Neurology, Duke University School of Medicine, Durham, NC
| | - Lisa Monk
- Duke Clinical Research Institute, Durham, NC
| | - Shreyansh Shah
- Department of Neurology, Duke University School of Medicine, Durham, NC
| | | | - Edwin Iversen
- Department of Statistical Science, Duke University, Durham NC
| | - James G Jollis
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Christopher B Granger
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Carmelo Graffagnino
- Department of Neurology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
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Puzzi M, Massago M, Gabella JL, de Oliveira SB, dos Santos DAM, Carignano FSN, Pelloso SM, Silva LL, Nihei OK, de Barros Carvalho MD, de Carvalho Dutra A, de Andrade L. Mortality in Women with Coronary Artery Disease in Paraná State, Brazil: A Bayesian Spatiotemporal Analysis. Glob Heart 2024; 19:15. [PMID: 38312999 PMCID: PMC10836177 DOI: 10.5334/gh.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/12/2024] [Indexed: 02/06/2024] Open
Abstract
Background Mortality resulting from coronary artery disease (CAD) among women is a complex issue influenced by many factors that encompass not only biological distinctions but also sociocultural, economic, and healthcare-related components. Understanding these factors is crucial to enhance healthcare provisions. Therefore, this study seeks to identify the social and clinical variables related to the risk of mortality caused by CAD in women aged 50 to 79 years old in Paraná state, Brazil, between 2010 and 2019. Methods This is an ecological study based on secondary data sourced from E-Gestor, IPARDES, and DATASUS. We developed a model that integrates both raw and standardized coronary artery disease (CAD) mortality rates, along with sociodemographic and healthcare service variables. We employed Bayesian spatiotemporal analysis with Markov Chain Monte Carlo simulations to assess the relative risk of CAD mortality, focusing specifically on women across the state of Paraná. Results A total of 14,603 deaths from CAD occurred between 2010 and 2019. Overall, temporal analysis indicates that the risk of CAD mortality decreased by around 22.6% between 2010 (RR of 1.06) and 2019 (RR of 0.82). This decline was most prominent after 2014. The exercise stress testing rate, accessibility of cardiology centers, and IPARDES municipal performance index contributed to the reduction of CAD mortality by approximately 4%, 8%, and 34%, respectively. However, locally, regions in the Central-West, Central-South, Central-East, and Southern regions of the Central-North parts of the state exhibited risks higher-than-expected. Conclusion In the last decade, CAD-related deaths among women in Paraná state decreased. This was influenced by more exercise stress testing, better access to cardiology centers, improved municipal performance index. Yet, elevated risks of deaths persist in certain regions due to medical disparities and varying municipal development. Therefore, prioritizing strategies to enhance women's access to cardiovascular healthcare in less developed regions is crucial.
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Affiliation(s)
- Marcelo Puzzi
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Brazil
| | - Miyoko Massago
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Brazil
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá, Maringá, Brazil
| | - Júlia Loverde Gabella
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá, Maringá, Brazil
- Department of Medicine, State University of Maringá, Maringá, Brazil
| | | | - Daniel Augusto Message dos Santos
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Brazil
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá, Maringá, Brazil
| | - Fernanda Shizue Nishida Carignano
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Brazil
- Department of Medicine, State University of Maringá, Maringá, Brazil
| | - Sandra Marisa Pelloso
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Brazil
| | - Lincoln Luis Silva
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá, Maringá, Brazil
- Department of Emergency Medicine, Duke University School of Medicine, Durham, United States of America
| | - Oscar Kenji Nihei
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá, Maringá, Brazil
- Education, Letters and Health Center, State University of the West of Paraná, Foz do Iguaçu, Brazil
| | | | - Amanda de Carvalho Dutra
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Brazil
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá, Maringá, Brazil
| | - Luciano de Andrade
- Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Brazil
- Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá, Maringá, Brazil
- Department of Medicine, State University of Maringá, Maringá, Brazil
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Shen M, Lu H, Liao Y, Wang J, Guo Y, Zhou X, Nong Y, Fu Z, Wang J, Guo Y, Zhao S, Fan L, Tian J. Intracoronary artery retrograde thrombolysis for ST-segment elevation myocardial infarction with a tortuous coronary artery: A case report and review of the literature. Front Cardiovasc Med 2022; 9:934489. [PMID: 35990969 PMCID: PMC9386044 DOI: 10.3389/fcvm.2022.934489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background How to deal with large thrombus burdens of culprit’s blood vessel remains a great challenge in the treatment of acute myocardial infarction. Case presentation A 32-year-old Chinese man was diagnosed with ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed that the distal end of a tortuous left circumflex was completely occluded by a large amount of thrombus. Cutted balloon-directed intracoronary artery retrograde thrombolysis (ICART) with urokinase led to the restoration of coronary blood flow. Because there was no obvious plaque rupture or artery stenosis in the coronary artery, it was only dilated, and no stent was implanted. Conclusion Cutted balloon-directed ICART can be performed effectively and safely in some STEMI patients with tortuous coronary vessels and large thrombus. (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).
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Affiliation(s)
- Mingzhi Shen
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haihui Lu
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Yichao Liao
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Jian Wang
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Yi Guo
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Xinger Zhou
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yingqiao Nong
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhenhong Fu
- Department of Cardiology, Sixth Medical Center, PLA General Hospital, Beijing, China
| | - Jihang Wang
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Yuting Guo
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shihao Zhao
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- *Correspondence: Shihao Zhao,
| | - Li Fan
- Department of Cardiology, Second Medical Center, PLA General Hospital, Beijing, China
- Li Fan,
| | - Jinwen Tian
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Jinwen Tian,
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Ishiyama M, Kurita T, Takasaki A, Takamura T, Masuda J, Ishikura K, Seko T, Setsuda M, Kasai A, Imai H, Dohi K. Impact of Helicopter Transport on Reperfusion Times and Long-Term Outcomes in Acute Myocardial Infarction Patients in Rural Areas: A Report From the Mie Acute Coronary Syndrome Registry. Air Med J 2021; 40:337-343. [PMID: 34535242 DOI: 10.1016/j.amj.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/14/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) are effective for time-sensitive conditions, such as stroke and trauma. However, prognostic data on helicopter transport for acute myocardial infarction (AMI) patients are insufficient. METHODS We registered 2,681 AMI patients in the Mie Acute Coronary Syndrome Registry and enrolled 163 patients from rural areas to HEMS base hospitals with HEMS or ground emergency medical services (GEMS). They were categorized into 4 groups according to the transportation method for interhospital transfer (direct HEMS: n = 52, direct GEMS: n = 54, interhospital HEMS: n = 32, and interhospital GEMS: n = 25). The primary end point was the emergency medical services (EMS) call-to-balloon time. The secondary end point was 2-year major adverse cardiac and cerebrovascular events. RESULTS The direct HEMS group was younger than the direct GEMS group (P = .029). The EMS call-to-balloon time was shorter in the direct HEMS and interhospital HEMS groups than in each GEMS group (P = .015 and P = .046). The incidence of 2-year major adverse cardiac and cerebrovascular events tended to be lower in both HEMS groups than in each GEMS group. CONCLUSION Direct HEMS for AMI in rural areas shortens the time from the EMS call to reperfusion when the transport distance is expected to exceed 30 km, which may result in a better patient prognosis. In addition, prehospital diagnostic modalities, such as 12-lead electrocardiography and echocardiography, may shorten the duration from the EMS call to reperfusion.
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Affiliation(s)
- Masaki Ishiyama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - Akihiro Takasaki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Takeshi Takamura
- Department of Cardiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Jun Masuda
- Department of Cardiology, Mie Prefectural General Medical Center, Yokkaichi, Mie, Japan
| | - Ken Ishikura
- Emergency Critical Care Center, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Tetsuya Seko
- Department of Cardiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Morimichi Setsuda
- Emergency and Critical Care Center, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Atsunobu Kasai
- Department of Cardiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Hiroshi Imai
- Emergency Critical Care Center, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Finlay E, Palmer S, Abes B, Abo B, Fishe JN. Clinical, Operational, and Socioeconomic Analysis of EMS Bypass of the Closest Facility for Pediatric Asthma Patients. West J Emerg Med 2021; 22:972-978. [PMID: 35353998 PMCID: PMC8328167 DOI: 10.5811/westjem.2021.4.50382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/13/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Pediatric hospital care is becoming increasingly regionalized, with fewer facilities providing inpatient care for common conditions such as asthma. That trend has major implications for emergency medical services (EMS) medical care and operations because EMS historically transports patients to the closest facility. This study describes EMS transport patterns of pediatric asthma patients in greater depth, including an analysis of facility bypass rates and the association of bypass with demographics and clinical outcomes. Methods This was a retrospective study of pediatric asthma patients ages 2–18 years transported by Lee County, FL EMS between March 1, 2018 – December 31, 2019. A priori, we defined bypass as greater than five minutes extra transport time. We performed geospatial analysis and mapping of EMS pediatric asthma encounters. We used the Pediatric Destination Tree (PDTree) project’s tiered approach to characterize receiving hospital facility pediatric capability. We analyzed incidence and characteristics of bypass, and bypass and non-bypass patient characteristics including demographics, emergency department (ED) clinical outcomes, and socioeconomic disadvantage (SED). Results From the study period, there were a total of 262 encounters meeting inclusion criteria, 254 (96.9%) of which could be geocoded to EMS incident and destination locations. Most encounters (72.8%) bypassed at least one facility, and the average number of facilities bypassed per encounter was 1.52. For all 185 bypass encounters, there was a median additional travel time of 13.5 minutes (interquartile range 7.5 – 17.5). Using the PDTree’s classification of pediatric capability of destination facilities, 172 of the 185 bypasses (93%) went to a Level I facility. Bypass incidence varied significantly by age, but not by minority status, asthma severity, or by the area deprivation index of the patient’s home address. Overall, the highest concentrations of EMS incidents tended to occur in areas of greater SED. With regard to ED outcomes, ED length of stay did not vary between bypass and non-bypass patients (P = 0.54), and neither did hospitalization (P = 0.80). Conclusion We found high rates of bypass for pediatric EMS encounters for asthma exacerbations, and that bypass frequency was significantly higher in younger age groups. With national trends pointing toward increasing pediatric healthcare regionalization, bypass has significant implications for EMS operations.
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Affiliation(s)
- Erik Finlay
- University of Florida Geoplan Center, Gainesville, Florida
| | - Sam Palmer
- University of Florida Geoplan Center, Gainesville, Florida
| | - Benjamin Abes
- Lee County Emergency Medical Services, Fort Myers, Florida
| | - Benjamin Abo
- Lee County Emergency Medical Services, Fort Myers, Florida
| | - Jennifer N Fishe
- University of Florida College of Medicine - Jacksonville, Pediatric Emergency Department, Jacksonville, Florida
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Assessment of Transportation by Air for Patients with Acute ST-Elevation Myocardial Infarction from Non-PCI Centers. Healthcare (Basel) 2021; 9:healthcare9030299. [PMID: 33800429 PMCID: PMC8000528 DOI: 10.3390/healthcare9030299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/20/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the delays that can potentially occur in the emergency transfer of patients with ST-elevation myocardial infarction (STEMI) to percutaneous coronary intervention (PCI) centers. We conducted a retrospective study using the medical reports pertaining to 97 patients who presented to the Emergency Department of the Emergency County Hospital of Galati during the year of 2018 with the diagnosis of STEMI and meeting eligibility criteria for PCI, thus warranting transfer to a hospital with PCI facilities. The pick-up time of patients diagnosed with acute myocardial infarction from the emergency department by the transfer crew is significantly shorter (p < 0.05) than those transferred by air, regardless of the PCI center to which the transfer was performed, Iasi or Bucharest, when compared to the time required to process the patients transferred by land to the same PCI centers. The results of the study shows that the helicopter use for transferring acute myocardial infarction patients to a PCI center must be considered, given the distance between non-PCI and PCI centers is over 200 km.
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Hakim R, Revue E, Saint Etienne C, Marcollet P, Chassaing S, Decomis MP, Yafi W, Laure C, Gautier S, Godillon L, Akkoyun-Farinez J, Angoulvant D, Koning R, Motreff P, Grammatico-Guillon L, Rangé G. Does helicopter transport delay prehospital transfer for STEMI patients in rural areas? Findings from the CRAC France PCI registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:958-965. [DOI: 10.1177/2048872619848976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims:
The aim of this study was to analyse delays in emergency medical system transfer of ST-segment elevation myocardial infarction (STEMI) patients to percutaneous coronary intervention (PCI) centres according to transport modality in a rural French region.
Methods and results:
Data from the prospective multicentre CRAC / France PCI registry were analysed for 1911 STEMI patients: 410 transferred by helicopter and 1501 by ground transport. The primary endpoint was the percentage of transfers with first medical contact to primary percutaneous coronary intervention within the 90 minutes recommended in guidelines. The secondary endpoint was time of first medical contact to primary percutaneous coronary intervention. With helicopter transport, time of first medical contact to primary percutaneous coronary intervention in under 90 minutes was less frequently achieved than with ground transport (9.8% vs. 37.2%; odds ratio 5.49; 95% confidence interval 3.90; 7.73; P<0.0001). Differences were greatest for transfers under 50 km (13.7% vs. 44.7%; P<0.0001) and for primary transfers (22.4% vs. 49.6%; P<0.0001). The median time from first medical contact to primary percutaneous coronary intervention and from symptom onset to primary percutaneous coronary intervention (total ischaemic time) were significantly higher in the helicopter transport group than in the ground transport group (respectively, 137 vs. 103 minutes; P<0.0001 and 261 vs. 195 minutes; P<0.0001). There was no significant difference in inhospital mortality between the helicopter and ground transport groups (6.9% vs. 6.6%; P=0.88).
Conclusions:
Helicopter transport of STEMI patients was five times less effective than ground transport in maintaining the 90-minute first medical contact to primary percutaneous coronary intervention time recommended in guidelines, particularly for transfer distances less than 50 km.
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Affiliation(s)
- Radwan Hakim
- Cardiology Department, Les Hôpitaux de Chartres, France
| | - Eric Revue
- Emergency Unit Department, Les Hôpitaux de Chartres, France
| | | | | | | | | | - Wael Yafi
- Cardiology Department, Centre Hospitalo-régional de Orléans, France
| | | | | | | | | | - Denis Angoulvant
- Cardiology Department, Centre Hospitalo-Universitaire de Tours, France
| | - Rene Koning
- Cardiology Department, Clinique Saint-Hilaire, France
| | - Pascal Motreff
- Cardiology Department, Centre Hospitalo-Universitaire de Clermont-Ferrand, France
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Ehrlich ME, Kolls BJ, Roettig M, Monk L, Shah S, Xian Y, Jollis JG, Granger CB, Graffagnino C. Implementation of Best Practices-Developing and Optimizing Regional Systems of Stroke Care: Design and Methodology. Am Heart J 2020; 222:105-111. [PMID: 32028136 DOI: 10.1016/j.ahj.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/13/2020] [Indexed: 11/18/2022]
Abstract
The AHA Guidelines recommend developing multi-tiered systems for the care of patients with acute stroke.1 An ideal stroke system of care should ensure that all patients receive the most efficient and timely care, regardless of how they first enter or access the medical care system. Coordination among the components of a stroke system is the most challenging but most essential aspect of any system of care. The Implementation of Best Practices For Acute Stroke Care-Developing and Optimizing Regional Systems of Stroke Care (IMPROVE Stroke Care) project, is designed to implement existing guidelines and systematically improve the acute stroke system of care in the Southeastern United States. Project participation includes 9 hub hospitals, approximately 80 spoke hospitals, numerous pre-hospital agencies (911, fire, and emergency medical services) and communities within the region. The goal of the IMPROVE Stroke program is to develop a regional integrated stroke care system that identifies, classifies, and treats acute ischemic stroke patients more rapidly and effectively with reperfusion therapy. The project will identify gaps and barriers to implementation of stroke systems of care, leverage existing resources within the regions, aid in designing strategies to improve care processes, bring regional representatives together to agree on and implement best practices, protocols, and plans based on guidelines, and establish methods to monitor quality of care. The impact of implementation of stroke systems of care on mortality and long-term functional outcomes will be measured.
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Affiliation(s)
- Matthew E Ehrlich
- Department of Neurology, Duke University School of Medicine, Durham, NC.
| | - Brad J Kolls
- Department of Neurology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Lisa Monk
- Duke Clinical Research Institute, Durham, NC
| | - Shreyansh Shah
- Department of Neurology, Duke University School of Medicine, Durham, NC
| | - Ying Xian
- Department of Neurology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - James G Jollis
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Christopher B Granger
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC
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Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:458-467. [PMID: 31308838 PMCID: PMC6612613 DOI: 10.11909/j.issn.1671-5411.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5-10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3-17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.
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Yu SH, Shih HM, Chang SS, Chen WK, Li CY. Social media communication shorten door-to-balloon time in patients with ST-elevation myocardial infarction. Medicine (Baltimore) 2019; 98:e14791. [PMID: 30855493 PMCID: PMC6417545 DOI: 10.1097/md.0000000000014791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST-segment elevation myocardial infarction (STEMI). Many efforts had been made to reduce door-to-balloon (DTB) time in patients with STEMI. The objective of this study is to demonstrate how intrahospital social media communication reduced DTB times in STEMI patients requiring an interhospital transfer.We retrospectively enrolled patients with STEMI who had been transferred from other hospitals during 2016 and 2017. Patients were divided into 2 groups. The previewed group had an electrocardiogram (ECG) done at the first hospital that was previewed by the cardiologist via social media. The control group was treated using the conventional clinical approach. We compared DTB time and outcome between 2 groups.The 2 groups shared some similar clinical characteristics. However, the previewed group had significantly shorter DTB times than the control group (n = 51, DTB 52.61 ± 42.20 vs n = 89, DTB time 78.40 ± 50.64, P = .003). The time elapsed between ECG and the call to the laboratory decreased most apparently in the previewed group (-11.24 ± 48.81 vs 16.96 ± 33.08, P < .001). The previewed group also tended to have less in-hospital major adverse cardiovascular events (P = .091).When the patients with STEMI required transfer to the PCI-capable hospital, using social media to preview ECG reduced DTB time, mainly because the cardiologists activated the catheter laboratories much earlier, sometimes even before the patients arrived at the PCI-capable hospital.
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Affiliation(s)
- Shao-Hua Yu
- Department of Emergency Medicine, China Medical University Hospital, Graduate Institute of Clinical Medical Science, China Medical University
| | - Hong-Mo Shih
- Department of Emergency Medicine, China Medical University Hospital, Graduate Institute of Clinical Medical Science, China Medical University
| | - Shih-Sheng Chang
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital
| | - Wei-Kung Chen
- Department of Emergency Medicine, China Medical University Hospital, Graduate Institute of Clinical Medical Science, China Medical University
| | - Chi-Yuan Li
- Department of Anesthesiology, China Medical University Hospital, Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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11
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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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12
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Dauerman HL, Bates ER, Kontos MC, Li S, Garvey JL, Henry TD, Manoukian SV, Roe MT. Nationwide Analysis of Patients With ST-Segment–Elevation Myocardial Infarction Transferred for Primary Percutaneous Intervention. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.002450. [DOI: 10.1161/circinterventions.114.002450] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Current American College of Cardiology/American Heart Association guidelines recommend transfer and primary percutaneous coronary intervention (PCI) for ST-segment–elevation myocardial infarction (STEMI) patients within the time limit of first contact to device ≤120 minutes. We determined the hospital-level, patient-level, and process characteristics of timely versus delayed primary PCI for a diverse national sample of transfer patients confined to a travel distance that facilitates the process.
Methods and Results—
We studied 14 518 patients transferred from non–PCI-capable hospitals for primary PCI to 398 National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines hospitals between July 2008 and December 2012. Patients with estimated transfer times >60 minutes (by Google Maps driving times) were excluded from the analysis. Patients achieving first door-to-device time ≤120 minutes were compared with patients with delayed treatment; independent predictors of timely treatment were determined using generalized estimating equations logistic regression models. The median estimated transfer distance was 26.5 miles. First door-to-device ≤120 minutes was achieved in 65% of patients (n=9380); only 37% of the hospitals were high-performing hospitals (defined as risk-adjusted rate, ≥75% of transfer STEMI patients with ≤120-minute first door-to-device time). In addition to known predictors of delay (cardiogenic shock, cardiac arrest, and prolonged door-in door-out time), STEMI referral hospitals’ rural location and longer estimated transfer time were identified as predictors of delay. In this diverse national sample, regional and racial variations in care were observed. Finally, lower PCI hospital annual STEMI volume was a potent predictor of delay.
Conclusions—
More than one third of US STEMI patients transferred for primary PCI fail to achieve first door-to-device time ≤120 minutes, despite estimated transfer times <60 minutes. Delays are related to process variables, comorbidities, and lower annual PCI hospital STEMI volumes.
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Affiliation(s)
- Harold L. Dauerman
- From the University of Vermont Cardiovascular Research Institute, Burlington (H.L.D.); University of Michigan, Ann Arbor (E.R.B.); Virginia Commonwealth University, Richmond (M.C.K.); Duke Clinical Research Institute, Durham, NC (S.L., M.T.R.); Carolinas Medical Center, Charlotte, NC (J.L.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); and Hospital Corporation of America, Nashville, TN (S.V.M.)
| | - Eric R. Bates
- From the University of Vermont Cardiovascular Research Institute, Burlington (H.L.D.); University of Michigan, Ann Arbor (E.R.B.); Virginia Commonwealth University, Richmond (M.C.K.); Duke Clinical Research Institute, Durham, NC (S.L., M.T.R.); Carolinas Medical Center, Charlotte, NC (J.L.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); and Hospital Corporation of America, Nashville, TN (S.V.M.)
| | - Michael C. Kontos
- From the University of Vermont Cardiovascular Research Institute, Burlington (H.L.D.); University of Michigan, Ann Arbor (E.R.B.); Virginia Commonwealth University, Richmond (M.C.K.); Duke Clinical Research Institute, Durham, NC (S.L., M.T.R.); Carolinas Medical Center, Charlotte, NC (J.L.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); and Hospital Corporation of America, Nashville, TN (S.V.M.)
| | - Shuang Li
- From the University of Vermont Cardiovascular Research Institute, Burlington (H.L.D.); University of Michigan, Ann Arbor (E.R.B.); Virginia Commonwealth University, Richmond (M.C.K.); Duke Clinical Research Institute, Durham, NC (S.L., M.T.R.); Carolinas Medical Center, Charlotte, NC (J.L.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); and Hospital Corporation of America, Nashville, TN (S.V.M.)
| | - J. Lee Garvey
- From the University of Vermont Cardiovascular Research Institute, Burlington (H.L.D.); University of Michigan, Ann Arbor (E.R.B.); Virginia Commonwealth University, Richmond (M.C.K.); Duke Clinical Research Institute, Durham, NC (S.L., M.T.R.); Carolinas Medical Center, Charlotte, NC (J.L.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); and Hospital Corporation of America, Nashville, TN (S.V.M.)
| | - Timothy D. Henry
- From the University of Vermont Cardiovascular Research Institute, Burlington (H.L.D.); University of Michigan, Ann Arbor (E.R.B.); Virginia Commonwealth University, Richmond (M.C.K.); Duke Clinical Research Institute, Durham, NC (S.L., M.T.R.); Carolinas Medical Center, Charlotte, NC (J.L.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); and Hospital Corporation of America, Nashville, TN (S.V.M.)
| | - Steven V. Manoukian
- From the University of Vermont Cardiovascular Research Institute, Burlington (H.L.D.); University of Michigan, Ann Arbor (E.R.B.); Virginia Commonwealth University, Richmond (M.C.K.); Duke Clinical Research Institute, Durham, NC (S.L., M.T.R.); Carolinas Medical Center, Charlotte, NC (J.L.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); and Hospital Corporation of America, Nashville, TN (S.V.M.)
| | - Matthew T. Roe
- From the University of Vermont Cardiovascular Research Institute, Burlington (H.L.D.); University of Michigan, Ann Arbor (E.R.B.); Virginia Commonwealth University, Richmond (M.C.K.); Duke Clinical Research Institute, Durham, NC (S.L., M.T.R.); Carolinas Medical Center, Charlotte, NC (J.L.G.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); and Hospital Corporation of America, Nashville, TN (S.V.M.)
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13
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Ward MJ, Kripalani S, Storrow AB, Liu D, Speroff T, Matheny M, Thomassee EJ, Vogus TJ, Munoz D, Scott C, Fredi JL, Dittus RS. Timeliness of interfacility transfer for ED patients with ST-elevation myocardial infarction. Am J Emerg Med 2015; 33:423-9. [PMID: 25618768 PMCID: PMC4385487 DOI: 10.1016/j.ajem.2014.12.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Most US hospitals lack primary percutaneous coronary intervention (PCI) capabilities to treat patients with ST-elevation myocardial infarction (STEMI) necessitating transfer to PCI-capable centers. Transferred patients rarely meet the 120-minute benchmark for timely reperfusion, and referring emergency departments (EDs) are a major source of preventable delays. We sought to use more granular data at transferring EDs to describe the variability in length of stay at referring EDs. METHODS We retrospectively analyzed a secondary data set used for quality improvement for patients with STEMI transferred to a single PCI center between 2008 and 2012. We conducted a descriptive analysis of the total time spent at each referring ED (door-in-door-out [DIDO] interval), periods that comprised DIDO (door to electrocardiogram [EKG], EKG-to-PCI activation, and PCI activation to exit), and the relationship of each period with overall time to reperfusion (medical contact-to-balloon [MCTB] interval). RESULTS We identified 41 EDs that transferred 620 patients between 2008 and 2012. Median MCTB was 135 minutes (interquartile range [IQR] 114,172). Median overall ED DIDO was 74 minutes (IQR 56,103) and was composed of door to EKG, 5 minutes (IQR 2,11); EKG-to-PCI activation, 18 minutes (IQR 7,37); and PCI activation to exit, 44 minutes (IQR 34,56). Door-in door-out accounted for the largest proportion (60%) of overall MCTB and had the largest variability (coefficient of variability, 1.37) of these intervals. CONCLUSIONS In this cohort of transferring EDs, we found high variability and substantial delays after EKG performance for patients with STEMI. Factors influencing ED decision making and transportation coordination after PCI activation are a potential target for intervention to improve the timeliness of reperfusion in patients with STEMI.
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Affiliation(s)
- Michael J Ward
- Department of Emergency Medicine, Vanderbilt University School of Medicine, 1313 21st Ave, Nashville, TN 37232.
| | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Center for Clinical Quality and Implementation Research, Vanderbilt University School of Medicine, 1313 21st Ave, Nashville, TN 37232
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University School of Medicine, 1313 21st Ave, Nashville, TN 37232
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University School of Medicine, 1313 21st Ave, Nashville, TN 37232
| | - Theodore Speroff
- Departments of Medicine and Biostatistics, Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN; Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | - Michael Matheny
- Departments of Biomedical Informatics and Medicine, Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN; Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | - Eric J Thomassee
- Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN
| | - Daniel Munoz
- Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN
| | - Carol Scott
- Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN
| | - Joseph L Fredi
- Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN
| | - Robert S Dittus
- Department of Medicine, Institute for Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN; Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
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14
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Nicholson BD, Dhindsa HS, Roe MT, Chen AY, Jollis JG, Kontos MC. Relationship of the distance between non-PCI hospitals and primary PCI centers, mode of transport, and reperfusion time among ground and air interhospital transfers using NCDR's ACTION Registry-GWTG: a report from the American Heart Association Mission: Lifeline Program. Circ Cardiovasc Interv 2014; 7:797-805. [PMID: 25406204 DOI: 10.1161/circinterventions.113.001307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND ST-segment myocardial infarction patients frequently present to non-percutaneous coronary intervention (PCI) hospitals and require interhospital transfer for primary PCI. The effect of distance and mode of transport to the PCI center and the frequency that recommended primary PCI times are met are not clear. METHODS AND RESULTS Data from the ACTION Registry(®)-GWTG™ were used to determine the distance between the Non-PCI and PCI center and first door time to balloon time based on transfer mode (ground and air) for patients having interhospital transfer for primary PCI. From July 1, 2008, to December 31, 2012, 17 052 ST-segment myocardial infarction patients were transferred to 413 PCI hospitals. The median distance from the non-PCI hospital to the primary PCI center was 31.9 miles (Q1, Q3: 19.1, 47.9; ground 25.2 miles; air 43.9 miles; P<0.001). At distances <40 miles, ground transport was the primary transport method, whereas at distances >40 miles air transport predominanted. Median first door time to balloon time time for patients transferred for primary PCI was 118 minutes (Q1, Q3: 95 152), with time for patients transported by air significantly longer (median 124 versus 113 minutes; respectively, P<0.001) than for patients transported by ground. Fifty-three percent of patients had a first door time to balloon time ≤120 minutes, with only 20% ≤90 minutes. A first door time to balloon time ≤120 minutes was more likely in ground than in air transport patients (57.0% versus 45.6%; P<0.001). CONCLUSIONS Interhospital transfer for primary PCI is associated with prolonged reperfusion times. These delays should prompt increased consideration of fibrinolytic therapy, emergency medical services hospital bypass protocols, and improved systems of care for ST-segment myocardial infarction patients requiring transfer.
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Affiliation(s)
- Benjamin D Nicholson
- From the Virginia Commonwealth University (B.D.N.), Department of Emergency Medicine (H.S.D.), and Department of Internal Medicine (M.C.K.), Richmond, VA; and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.T.R., A.Y.C., J.G.J.); and on behalf of the NCDR
| | - Harinder S Dhindsa
- From the Virginia Commonwealth University (B.D.N.), Department of Emergency Medicine (H.S.D.), and Department of Internal Medicine (M.C.K.), Richmond, VA; and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.T.R., A.Y.C., J.G.J.); and on behalf of the NCDR
| | - Matthew T Roe
- From the Virginia Commonwealth University (B.D.N.), Department of Emergency Medicine (H.S.D.), and Department of Internal Medicine (M.C.K.), Richmond, VA; and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.T.R., A.Y.C., J.G.J.); and on behalf of the NCDR
| | - Anita Y Chen
- From the Virginia Commonwealth University (B.D.N.), Department of Emergency Medicine (H.S.D.), and Department of Internal Medicine (M.C.K.), Richmond, VA; and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.T.R., A.Y.C., J.G.J.); and on behalf of the NCDR
| | - James G Jollis
- From the Virginia Commonwealth University (B.D.N.), Department of Emergency Medicine (H.S.D.), and Department of Internal Medicine (M.C.K.), Richmond, VA; and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.T.R., A.Y.C., J.G.J.); and on behalf of the NCDR
| | - Michael C Kontos
- From the Virginia Commonwealth University (B.D.N.), Department of Emergency Medicine (H.S.D.), and Department of Internal Medicine (M.C.K.), Richmond, VA; and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.T.R., A.Y.C., J.G.J.); and on behalf of the NCDR.
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15
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Simon EL, Griffin P, Medepalli K, Griffin G, Williams CJ, Hewit M, Lloyd TS. Door-to-Balloon Times from Freestanding Emergency Departments Meet ST-Segment Elevation Myocardial Infarction Reperfusion Guidelines. J Emerg Med 2014; 46:734-40. [DOI: 10.1016/j.jemermed.2013.08.089] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/03/2013] [Accepted: 08/15/2013] [Indexed: 10/25/2022]
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16
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Circulation: Cardiovascular Interventions
Editors’ Picks. Circ Cardiovasc Interv 2013. [DOI: 10.1161/circinterventions.113.001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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17
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Todoran TM, Powers ER. Acute ST elevation myocardial infarction in patients hospitalized for non-cardiac conditions: the next challenge in reperfusion time. J Am Heart Assoc 2013; 2:e000182. [PMID: 23598275 PMCID: PMC3647242 DOI: 10.1161/jaha.113.000182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas M. Todoran
- Division of Cardiology, Medical University of South Carolina, Charleston, SC (T.M.T., E.R.P.)
- Correspondence to: Thomas M. Todoran, MD, MSc, 25 Courtenay Drive MSC 592, Charleston, SC 29425. E‐mail:
| | - Eric R. Powers
- Division of Cardiology, Medical University of South Carolina, Charleston, SC (T.M.T., E.R.P.)
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