Coronary artery disease
Door-to-Balloon Times in Hospitals Within the Get-With-The-Guidelines Registry After Initiation of the Door-to-Balloon (D2B) Alliance

https://doi.org/10.1016/j.amjcard.2008.12.030Get rights and content

To improve hospital performance in door-to-balloon (DTB) times nationally, the American College of Cardiology D2B Alliance recently enrolled approximately 1,000 hospitals that perform percutaneous coronary intervention (PCI) across the United States in a large national quality improvement effort. We evaluated recent changes in DTB times in hospitals within the Get-With-The-Guidelines (GWTG) Coronary Artery Disease (CAD) program, a partner in the D2B Alliance. Within GWTG-CAD participating hospitals, we studied DTB in nontransferred patients with ST-elevation myocardial infarction treated with primary PCI from July 2006 to March 2008. We evaluated the percentage of patients treated within 90 minutes and used multivariable models with generalized estimating equations to examine trends over time after accounting for changes in patients' characteristics. A total of 5,801 patients at 167 hospitals were included in our analysis, with 3,567 patients at 98 hospitals that joined the D2B Alliance. From July to September 2006, 54.1% of patients received primary PCI within 90 minutes. This number increased significantly during the study period: 335 (74.1%) of 452 patients at GWTG-CAD participating hospitals were treated within 90 minutes from January to March 2008, including 229 of 304 patients (75.3%) treated at hospitals that joined the D2B Alliance and 106 of 148 patients (71.6%) treated at other GWTG-CAD participating hospitals (p <0.001 for all comparisons over time). No statistically significant differences were noted in the rate of change between hospitals that joined the D2B Alliance and other GWTG-CAD participating hospitals. In conclusion, the percentage of patients treated with 90 minutes has dramatically increased at hospitals participating within the GWTG-CAD program, coinciding with the launch of the D2B Alliance. These improvements were broad and not limited to hospitals that joined the D2B Alliance.

Section snippets

Methods

The goals and rationale of the D2B Alliance have been recently described in detail.3 Briefly, it is a large quality improvement effort that was launched by the American College of Cardiology in partnership with several other health care organizations including the American Heart Association and the GTWG-CAD program. To date, the D2B Alliance has enrolled approximately 1,000 hospitals with a goal to achieve D2B times of ≤90 minutes for ≥75% of nontransferred patients with STEMI undergoing

Results

We identified 5,801 nontransferred patients with STEMI treated with primary PCI at 167 GWTG-CAD participating hospitals during the study period. Of these, 3,567 patients were treated at 98 hospitals that formally joined the D2B Alliance and 2,234 patients were treated at 69 hospitals that did not. Table 1, Table 2 present patients' clinical factors and performance measurements at GWTG-CAD participating hospitals, stratified by whether the patients were treated at hospitals that joined the D2B

Discussion

We found significant improvements in DTB times among GWTG-CAD participating hospitals, coinciding with the launch of the D2B Alliance. The primary target of DTB times within 90 minutes in ≥75% of patients established by the D2B Alliance was nearly reached among all GWTG-CAD participating hospitals, and the target was exceeded by the 98 GWTG-CAD participating hospitals that formally joined the D2B Alliance. This achievement is the culmination of a series of important events over the previous 5

Acknowledgment

We acknowledge the support of Louise Morgan, MSN, and the hospitals participating in the D2B Alliance and the GWTG programs, the American College of Cardiology, and the American Heart Association. We also thank Sally Ramon-English for her help with preparing the report.

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