Door-to-Balloon Times Show Dramatic Improvement in the US

August 22, 2011—The American Heart Association (AHA) announced findings from a study showing that > 90% of the ST-elevated myocardial infarction patients who require emergency angioplasty are treated within the recommended 90 minutes from hospital arrival compared to 5 years before the period analyzed in the study, when less than half of these patients were treated in this timeframe. Harlan M. Krumholz, MD, et al published the study online ahead of print in Circulation.

According to the AHA, the study is one of the most comprehensive analyses of angioplasty timeliness. The investigators found that 91% of patients were treated with a door-to-balloon time of < 90 minutes in 2010 compared with only 44% in 2005, and 70% of patients were treated in < 75 minutes in 2010 compared with 27% in 2005. The median time from hospital admission to emergency angioplasty declined from 96 to 64 minutes during the years studied.

“Everybody had to improve to get a national report card like this,” commented Dr. Krumholz. “This remarkable improvement demonstrates what we can achieve when we work together and is a tribute to the doctors, nurses, and other health care professionals that applied the information from the research studies about how best to deliver care to ensure that patients are treated rapidly.”

Dr. Krumholz added, “At the beginning of these efforts, many said that this level of improvement was impossible to achieve. This is an opportunity to reflect on our achievement and to recognize that when we identify quality issues and problems in our health care system, we can work as a community to generate new knowledge to apply to practice and improve care for patients.”

The investigators analyzed nationwide hospital data collected by the Centers for Medicare & Medicaid Services from more than 300,000 patients undergoing emergency angioplasty from January 1, 2005, to September 30, 2010, including those not covered by Medicare.

Dr. Krumholz noted that the recent progress stems from a concerted nationwide effort between federal agencies, health care organizations, and clinicians to improve heart attack care and outcomes by accelerating treatment. Major initiatives include Hospital Compare, which was launched in September 2005 as part of the Centers for Medicare & Medicaid Services program to publicly report the percentage of patients treated within recommended times. The D2B Alliance was launched in November 2006 by the American College of Cardiology with national partners to improve door-to-balloon times by advocating the adoption of key strategies shown to reduce delays based on a study funded by the National Heart, Lung, and Blood Institute. Mission: Lifeline was launched in May 2007 by the AHA to improve community-wide systems of care for patients with ST-elevated myocardial infarction. Through Mission: Lifeline, systems of care are working to get patients to call 911 faster, improve the response time and capabilities of the emergency medical service teams, provide faster triage and transport from hospitals that do not provide angioplasty to those that do, and ensure that the receiving hospital's team is in place ready to treat the patient as quickly as possible upon arrival.

“The findings of this study are remarkable in that there has been a dramatic improvement in timely care of heart attacks across the entire country,” stated Chris Granger, MD, who serves as Chairman of the Mission: Lifeline steering committee. “It shows what can be accomplished with systematic quality improvement efforts based on sound evidence. The results of this study reinforce the value of ongoing efforts to extend these improvements to emergency medical services, networks of hospitals, and to all aspects of care of heart attacks, as is now being done in Mission: Lifeline.”