CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

August 23rd, 2011

Door-to-Balloon Time Closes In On 1 Hour

The door-to-balloon (D2B) time has fallen substantially since the launch of the D2B Alliance campaign in 2006, according to a new report in Circulation. Harlan Krumholz (editor-in-chief of CardioExchange) and colleagues analyzed data reported to CMS from the beginning of 2005 through September 2010.

  • D2B dropped from 96 minutes in 2005 to 64 minutes in the first 9 months of 2010.
  • The percentage of patients treated within 90 minutes increased from 44.2% to 91.4%.
  • The percentage of patients treated within 75 minutes increased from 27.3% to 70.4%.

The investigators reported that the biggest improvements were observed in groups that initially had the highest median times, including patients over 75 years of age, women, and blacks. They noted that the shift toward a 90-minute standard was provoked by the observation that primary PCI was superior to fibrinolytic therapy only if it could be given no later than 1 hour after fibrinolytic therapy would have been delivered.

Opportunities for improvement still remain, the authors write. The best hospitals now regularly achieve D2B times of 60 minutes and “this level of performance may become the new standard.” In addition, many patients experience long delays when they are transferred to a hospital without PCI capability to a PCI-capable hospital.

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

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