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A Review of Interventions and System Changes to Improve Time to Reperfusion for ST-Segment Elevation Myocardial Infarction

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Abstract

Objective

Identify and describe interventions to reduce time to reperfusion for patients with ST-segment elevation myocardial infarction (STEMI).

Data Source

Key word searches of five research databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, and Cochrane Clinical Trials Registry.

Interventions

We included controlled and uncontrolled studies of interventions to reduce time to reperfusion. One researcher reviewed abstracts and 2 reviewed full text articles. Articles were subsequently abstracted into structured data tables, which included study design, setting, intervention, and outcome variables. We inductively developed intervention categories from the articles. A second researcher reviewed data abstraction for accuracy.

Measurements and Main Results

We identified 666 articles, 42 of which met inclusion criteria. We identified 11 intervention categories and classified them as either process specific (e.g., emergency department administration of thrombolytic therapy, activation of the catheterization laboratory by emergency department personnel) or system level (e.g., continuous quality improvement, critical pathways). A majority of studies (59%) were single-site pre/post design, and nearly half (47%) had sample sizes less than 100 patients. Thirty-two studies (76%) reported significantly lower door to reperfusion times associated with an intervention, 12 (29%) of which met or exceeded guideline recommended times. Relative decreases in times to reperfusion ranged from 15 to 82% for door to needle and 13–64% for door to balloon.

Conclusions

We identified an array of process and system-based quality improvement interventions associated with significant improvements in door to reperfusion time. However, weak study designs and inadequate information about implementation limit the usefulness of this literature.

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Acknowledgment

This work was supported by the Office of Research and Development, Health Services R&D Service, Department of Veterans Affairs, project number IHD 04–0001. The views expressed are those of the authors and do not reflect the views of the Department of Veterans Affairs.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. VA Puget Sound Health Care System, Seattle, WA, USA

    Kelly A. McDermott MA, Christian D. Helfrich PhD, Anne E. Sales PhD & Stephan D. Fihn MD MPH

  2. University of Alberta, Edmonton, Alberta, Canada

    Anne E. Sales PhD

  3. VA Eastern Colorado Health Care System, Denver, CO, USA

    John S. Rumsfeld MD, PhD & P. Michael Ho MD PhD

  4. Edmonton, AB, Canada

    Anne E. Sales PhD

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  1. Kelly A. McDermott MA
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  2. Christian D. Helfrich PhD
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Correspondence to Anne E. Sales PhD.

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McDermott, K.A., Helfrich, C.D., Sales, A.E. et al. A Review of Interventions and System Changes to Improve Time to Reperfusion for ST-Segment Elevation Myocardial Infarction. J GEN INTERN MED 23, 1246–1256 (2008). https://doi.org/10.1007/s11606-008-0563-7

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  • DOI: https://doi.org/10.1007/s11606-008-0563-7

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