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RESEARCH PRODUCT

On versus off-hour care of patients with acute coronary syndrome and persistent ST-segment elevation in certified German chest pain units

Frank BreuckmannMichael HaudeSebastian BarthJochen SengesGerhard SchulerMatthias HochadelBirgit HailerThomas VoigtländerThomas MünzelBurghard SchumacherGerd HeuschEvangelos GiannitsisHarald MudraClaus SchmittDirk Walther

subject

MaleAcute coronary syndromePercutaneousmedicine.medical_treatmentMedizin030204 cardiovascular system & hematologyCritical Care and Intensive Care MedicineBioinformaticsBalloonChest painTime-to-Treatment03 medical and health sciences0302 clinical medicineAfter-Hours CareGermanyMyocardial RevascularizationmedicineHumansST segment030212 general & internal medicineMyocardial infarctionAcute Coronary SyndromeAngioplasty Balloon CoronaryAgedbusiness.industryPercutaneous coronary interventionGeneral MedicineMiddle Agedmedicine.diseaseAnesthesiaDoor-to-balloonST Elevation Myocardial InfarctionFemalemedicine.symptomCardiology and Cardiovascular Medicinebusiness

description

BACKGROUND Regional healthcare projects improve the off-hour care of patients with acute coronary syndromes and persistent ST-segment elevation myocardial infarction (STEMI). To analyse differences in quality of care between on and off-hour care of STEMI patients admitted to certified German chest pain units. METHODS A total of 1107 STEMI patients from the German chest pain unit registry were enrolled. Analyses comprised critical time intervals (symptoms to first medical contact (FMC), FMC to admission, symptoms to admission, symptoms to balloon, FMC to balloon, door to balloon times) and major adverse cardiac and cerebrovascular events at follow-up. RESULTS 54.8% of patients were admitted off-hours. Symptoms to admission (2:28 (1:28-5:20 h) vs. 3:16 h (1:35-8:06 h), P<0.001), symptoms to FMC (1:15 h (0:33-3:00 h) vs. 2:00 h (0:40-6:46 h), P<0.001) and FMC to admission intervals (0:45 h (0:30-1:20 h) vs. 0:52 h (0:32-1:35 h), P=0.09) were shorter during off-hours. Percutaneous revascularisation rates were high and without difference between on and off-hours (95.5% vs. 96.8%, P=0.30). Door to balloon times were significantly less during on-hours (0:32 h (0:18-1:06 h) vs. 0:44 h (0:23-1:20 h), P<0.01) without negative impact on the proportion of patients with a door to balloon time of <60 min (72.6% vs. 68.4%, P=0.19), symptoms to balloon (3:49 h (2:12-10:46 h) vs. 3:30 h (2:04-7:41 h), P=0.08) or FMC to balloon times (1:26 h (0:56-2:22 h) vs. 1:30 h (1:03-2:29 h), P=0.14). Major adverse cardiac and cerebrovascular event rates did not differ significantly between on and off-hours (log-rank test P=0.36). CONCLUSIONS The German chest pain unit network ensures rapid and structured preclinical and in-hospital care independent from the circadian variation of admission. Slower door to balloon times off-hours are compensated by faster symptoms to admission or symptoms to FMC intervals. Further efforts should focus on patient awareness programmes on-hours and STEMI alarming tracks off-hours.

yearjournalcountryeditionlanguage
2016-09-22
10.1177/2048872615624845https://www.ncbi.nlm.nih.gov/pubmed/26714975