Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated: An Opportunity for Better Coordination of Acute Care

Kori Sauser Zachrison; Deborah A Levine; Gregg C Fonarow; Deepak L Bhatt; Margueritte Cox; Phillip Schulte; Eric E Smith; Robert E Suter; Ying Xian; Lee H Schwamm

doi:10.1161/CIRCOUTCOMES.116.003148

Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated: An Opportunity for Better Coordination of Acute Care

Circ Cardiovasc Qual Outcomes. 2017 Mar;10(3):e003148. doi: 10.1161/CIRCOUTCOMES.116.003148.

Affiliations

¹ From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.). kzachrison@mgh.harvard.edu.
² From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.).

Abstract

Background: Timely reperfusion is critical in acute ischemic stroke (AIS) and ST-segment-elevation myocardial infarction (STEMI). The degree to which hospital performance is correlated on emergent STEMI and AIS care is unknown. Primary objective of this study was to determine whether there was a positive correlation between hospital performance on door-to-balloon (D2B) time for STEMI and door-to-needle (DTN) time for AIS, with and without controlling for patient and hospital differences.

Methods and results: Prospective study of all hospitals in both Get With The Guidelines-Stroke and Get With The Guidelines-Coronary Artery Disease from 2006 to 2009 and treating ≥10 patients. We compared hospital-level DTN time and D2B time using Spearman rank correlation coefficients and hierarchical linear regression modeling. There were 43 hospitals with 1976 AIS and 59 823 STEMI patients. Hospitals' DTN times for AIS did not correlate with D2B times for STEMI (ρ=-0.09; P=0.55). There was no correlation between hospitals' proportion of eligible patients treated within target time windows for AIS and STEMI (median DTN time <60 minutes: 21% [interquartile range, 11-30]; median D2B time <90 minutes: 68% [interquartile range, 62-79]; ρ=-0.14; P=0.36). The lack of correlation between hospitals' DTN and D2B times persisted after risk adjustment. We also correlated hospitals' DTN time and D2B time data from 2013 to 2014 using Get With The Guidelines (DTN time) and Hospital Compare (D2B time). From 2013 to 2014, hospitals' DTN time performance in Get With The Guidelines was not correlated with D2B time performance in Hospital Compare (n=546 hospitals).

Conclusions: We found no correlation between hospitals' observed or risk-adjusted DTN and D2B times. Opportunities exist to improve hospitals' performance of time-critical care processes for AIS and STEMI in a coordinated approach.

Keywords: American Heart Association; fibrinolysis; myocardial infarction; stroke; tissue-type plasminogen activator.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary / adverse effects
Angioplasty, Balloon, Coronary / methods*
Angioplasty, Balloon, Coronary / standards
Delivery of Health Care, Integrated / organization & administration*
Delivery of Health Care, Integrated / standards
Female
Fibrinolytic Agents / administration & dosage*
Fibrinolytic Agents / adverse effects
Humans
Male
Middle Aged
Myocardial Reperfusion / adverse effects
Myocardial Reperfusion / methods*
Myocardial Reperfusion / standards
Organizational Objectives
Patient Care Team / organization & administration
Prospective Studies
Quality Improvement / organization & administration*
Quality Improvement / standards
Quality Indicators, Health Care / organization & administration*
Quality Indicators, Health Care / standards
Registries
ST Elevation Myocardial Infarction / diagnosis
ST Elevation Myocardial Infarction / drug therapy*
Stroke / diagnosis
Stroke / drug therapy*
Thrombolytic Therapy / adverse effects
Thrombolytic Therapy / methods*
Thrombolytic Therapy / standards
Time Factors
Time-to-Treatment / organization & administration*
Time-to-Treatment / standards
Tissue Plasminogen Activator / administration & dosage*
Tissue Plasminogen Activator / adverse effects
United States

Substances

Fibrinolytic Agents
Tissue Plasminogen Activator

Grants and funding

K23 AG040278/AG/NIA NIH HHS/United States