CardioExchange Archive

May 7th, 2012

All Dressed Up and No Place to Go: False-Positive Activation of the Cath Lab for Primary PCI

Larry Husten, PHD

Primary PCI is widely recognized as the best early option for patients with  ST-segment elevation myocardial infarction (STEMI). However, efforts to deliver primary PCI to the broadest possible population inevitably result in an increased number of false-positive activations of the cardiac catheterization laboratory. Now, a new study published in the Archives of Internal Medicine finds that […]

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November 30th, 2011

Thrombolysis Instead of Primary PCI

Sanjiv Shah, MD

The latest analysis of 2009 CMS data for 13,776 STEMI patients of door-in to door-out (DIDO) time by Herrin and colleagues does not bring encouraging news. After many years of hard work to reduce DIDO time for patients who present at facilities without primary PCI capability, only a small fraction of patients (<10%) are transferred […]

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November 28th, 2011

Long Transfer Delays for STEMI Patients at Most Hospitals Without Primary PCI

Larry Husten, PHD

Fewer than 10% of STEMI patients eligible for PCI who arrive at a hospital without PCI capability are transferred within the recommended times, according to a new study published in the Archives of Internal Medicine. Although dramatic improvements in door-to-balloon times have been achieved in recent years in PCI-capable hospitals, the new report suggests that […]

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August 23rd, 2011

Door-to-Balloon Time Closes In On 1 Hour

Larry Husten, PHD

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 […]

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February 17th, 2011

Unreasonable Expectations for Quality Improvement

John E Brush, MD

At a recent committee meeting, my hospital’s administration announced new quality measures and targets. Striving for top performance, the board of the hospital system set the bar extraordinarily high. The bonuses of senior management are tied to achieving the targets, so the announcement had everyone’s attention. One target that caught my interest was for achieving a […]

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August 20th, 2010

Door to Balloon (D2B) Time: The Wrong Performance Measure?

Richard A. Lange, MD, MBA

The authors of a recently published study evaluated the association between system delay (i.e., time from the patient’s first contact with the health care system to initiation of reperfusion) and outcome in STEMI patients transported by EMS and treated with primary PCI.  Some patients were triaged directly to a PCI center, whereas others were transported to their […]

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August 17th, 2010

Going Beyond Door-to-Balloon by Starting Earlier

Larry Husten, PHD

Efforts to speed delivery of PCI to STEMI patients have focused on shortening the door-to-balloon time. Now a group of Danish researchers propose that efforts to improve care must include assessment of treatment from the time of the patient’s first contact with the emergency medical system. Analyzing historical data from 6209 MI patients who received […]

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