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Health care system delay may increase risk of death for heart patients receiving reperfusion therapy

Date:
August 17, 2010
Source:
JAMA and Archives Journals
Summary:
For patients with a certain type of heart attack, delay in the time between first contact with emergency medical service to initiation of therapy such as balloon angioplasty is associated with an increased risk of death.

For patients with a certain type of heart attack, delay in the time between first contact with emergency medical service to initiation of therapy such as balloon angioplasty is associated with an increased risk of death, according to a study in the August 18 issue of JAMA.

Timely reperfusion therapy with either fibrinolysis (the dissolution of fibrin) or primary percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) is recommended for patients with ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack). Door-to-balloon delay has been proposed as a performance measure in triaging patients for primary PCI. "However, focusing on the time from first contact with the health care system to the initiation of reperfusion therapy (system delay) may be more relevant, because it constitutes the total time to reperfusion modifiable by the health care system. No previous studies have focused on the association between system delay and outcome in patients with STEMI treated with primary PCI," the authors write.

Christian Juhl Terkelsen, M.D., Ph.D., of Aarhus University Hospital, Aarhus, Denmark, and colleagues assessed the associations between treatment, patient, system, and door-to-balloon delays and mortality in a large group of patients with STEMI treated with primary PCI. The study included data from Danish medical registries of patients with STEMI transported by emergency medical service and treated with primary PCI from January 2002 to December 2008 at 3 high-volume PCI centers in Western Denmark. Patients (n = 6,209) underwent primary PCI within 12 hours of symptom onset. The median (midpoint) follow-up time was 3.4 years.

The researchers found that when stratified according to intervals of system delay, long-term cumulative mortality was 15.4 percent (n = 43) in patients with system delays of 0 through 60 minutes (n = 347), 23.3 percent (n = 380) in those with delays of 61 through 120 minutes (n = 2,643), 28.1 percent (n = 378) in those with delays of 121 through 180 minutes (n = 2,092), and 30.8 percent (n = 275) in those with delays of 181 through 360 minutes (n = 1,127). "In multivariate analysis adjusted for other predictors of mortality, system delay was independently associated with mortality, as was its components, prehospital system delay and door-to-balloon delay," the authors write.

"We conclude that health care system delay is valuable as a performance measure when patients with STEMI are treated with primary PCI, because it is associated with mortality, it constitutes the part of treatment delay modifiable by the health care system in the acute phase, and it applies to patients field-triaged directly to the PCI center as well as to patients transferred from local hospitals. Increased focus on the total health care system delay may optimize triage of patients with STEMI and may be the key to further improving survival of these patients."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Christian Juhl Terkelsen et al. System Delay and Mortality Among Patients With STEMI Treated With Primary Percutaneous Coronary Intervention. JAMA The Journal of the American Medical Association, 2010; 304 (7): 763 DOI: 10.1001/jama.2010.1139

Cite This Page:

JAMA and Archives Journals. "Health care system delay may increase risk of death for heart patients receiving reperfusion therapy." ScienceDaily. ScienceDaily, 17 August 2010. <www.sciencedaily.com/releases/2010/08/100817161106.htm>.
JAMA and Archives Journals. (2010, August 17). Health care system delay may increase risk of death for heart patients receiving reperfusion therapy. ScienceDaily. Retrieved October 22, 2014 from www.sciencedaily.com/releases/2010/08/100817161106.htm
JAMA and Archives Journals. "Health care system delay may increase risk of death for heart patients receiving reperfusion therapy." ScienceDaily. www.sciencedaily.com/releases/2010/08/100817161106.htm (accessed October 22, 2014).

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