ACC's Door-to-Balloon Alliance Achieves Goal

December 2, 2009—The American College of Cardiology (ACC) announced results from its national campaign, the Door-to-Balloon (D2B) Alliance, to reduce D2B time for patients experiencing myocardial infarctions (MIs). The campaign sought to improve these times because guidelines recommended and various studies have shown that MI patients who are treated within 90 minutes of entering the hospital have a higher rate of survival than those who are treated later. The D2B Alliance reached its goal of 75% of patients with ST-segment elevation MI (STEMI) having D2B times within 90 minutes by 2008, according to a newly published study by Elizabeth H. Bradley, PhD, et al in the Journal of the American College of Cardiology (JACC. 2009;54:2423-2429).

According to the ACC, in 2005, approximately one-half of patients with STEMI who received a primary percutaneous coronary intervention (PCI) met the recommended 90-minute D2B time. The D2B Alliance was launched in November 2006 by the ACC and 38 partner organizations to help participating hospitals lower their D2B times. By March 2008, more than 75% of patients in those hospitals had D2B times of less than 90 minutes.

As detailed in JACC, the investigators conducted an evaluation of D2B times in 831 hospitals participating in the ACC's National Cardiovascular Data Registry (NCDR) CathPCI Registry from April 1, 2005, to March 31, 2008, to examine the use of D2B Alliance-recommended strategies, changes in D2B times before and after the launch of the program, and differences in D2B times for patients treated in D2B Alliance hospitals and hospitals not enrolled in the program. The prevalence of each strategy recommended by the D2B Alliance improved significantly during the time period measured, as did the 3-year trend in patient D2B times within 90 minutes, from 52.5% in 2005 to 62.8% in 2006 to 76.4% in 2008.

"This ambitious effort to improve timeliness of heart attack care has reported marked improvements with the vast majority of patients receiving life-saving care within 90 minutes of hospital arrival, as recommended by clinical guidelines," commented Dr. Bradley. "The improvement was across the nation, not just in a few hospitals or states. The movement changed the way heart attack care is delivered—for the benefit of patients."

Dr. Bradley added, "The key is to have a leader and a team devoted to a single goal and to be persistent, even when there are setbacks. Most of what we read about in health care reform is about health care financing. This effort shows that how care is organized can have tremendous impact, and with relatively little added resources."

The ACC noted that more recent data collected by the NCDR CathPCI Registry indicate that hospital performance has continued to improve beyond the end of the study period of March 31, 2008. The most recent available data from June 30, 2009, show that 81.7% of eligible patients receiving primary PCI had D2B times of less than 90 minutes. The average D2B time has dropped significantly as well, from an average of 121 minutes at the end of 2005 to an average of 80 minutes as of June 30, 2009.