| Dokumentenart: | Artikel | ||||
|---|---|---|---|---|---|
| Titel eines Journals oder einer Zeitschrift: | European Heart Journal. Acute Cardiovascular Care | ||||
| Verlag: | SAGE PUBLICATIONS LTD | ||||
| Ort der Veröffentlichung: | LONDON | ||||
| Band: | 10 | ||||
| Nummer des Zeitschriftenheftes oder des Kapitels: | 4 | ||||
| Seitenbereich: | S. 397-405 | ||||
| Datum: | 2020 | ||||
| Institutionen: | Medizin > Lehrstuhl für Innere Medizin II | ||||
| Identifikationsnummer: |
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| Stichwörter / Keywords: | ELEVATION MYOCARDIAL-INFARCTION; ST-SEGMENT-ELEVATION; TO-BALLOON TIME; PERCUTANEOUS CORONARY INTERVENTION; EMERGENCY-DEPARTMENT BYPASS; FORMALIZED DATA FEEDBACK; PRIMARY ANGIOPLASTY; FIELD TRIAGE; MORTALITY; MANAGEMENT; ST-segment elevation myocardial infarction (STEMI); percutaneous coronary intervention (PCI); feedback interventions; quality control measures; treatment times; mortality | ||||
| Dewey-Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin | ||||
| Status: | Veröffentlicht | ||||
| Begutachtet: | Ja, diese Version wurde begutachtet | ||||
| An der Universität Regensburg entstanden: | Ja | ||||
| Dokumenten-ID: | 50555 |
Web of ScienceZusammenfassung
Aims: Current European Society of Cardiology guidelines state that repetitive monitoring and feedback should be implemented for ST-elevation myocardial infarction (STEMI) treatment, but no evidence is available supporting this recommendation. We aimed to analyze the long-term effects of a formalized data assessment and systematic feedback on performance and mortality within the prospective, ...
Zusammenfassung
Aims: Current European Society of Cardiology guidelines state that repetitive monitoring and feedback should be implemented for ST-elevation myocardial infarction (STEMI) treatment, but no evidence is available supporting this recommendation. We aimed to analyze the long-term effects of a formalized data assessment and systematic feedback on performance and mortality within the prospective, multicenter Feedback Intervention and Treatment Times in STEMI (FITT-STEMI) study. Methods: Regular interactive feedback sessions with local STEMI management teams were performed at six participating German percutaneous coronary intervention (PCI) centers over a 10-year period starting from October 2007. Results: From the first to the 10th year of study participation, all predefined key-quality indicators for performance measurement used for feedback improved significantly in all 4926 consecutive PCI-treated patients - namely, the percentages of patients with pre-hospital electrocardiogram (ECG) recordings (83.3% vs 97.1%,p< 0.0001) and ECG recordings within 10 minutes after first medical contact (41.7% vs 63.8%,p< 0.0001), pre-announcement by telephone (77.0% vs 85.4%,p= 0.0007), direct transfer to the catheterization laboratory bypassing the emergency department (29.4% vs 64.2%,p< 0.0001), and contact-to-balloon times of less than 90 minutes (37.2% vs 53.7%,p< 0.0001). Moreover, this feedback-related continuous improvement of key-quality indicators was linked to a significant reduction in in-hospital mortality from 10.8% to 6.8% (p= 0.0244). Logistic regression models confirmed an independent beneficial effect of duration of study participation on hospital mortality (odds ratio = 0.986, 95% confidence interval = 0.976-0.996,p= 0.0087). In contrast, data from a nationwide PCI registry showed a continuous increase in in-hospital mortality in all PCI-treated STEMI patients in Germany from 2008 to 2015 (n= 398,027; 6.7% to 9.2%,p< 0.0001). Conclusions: Our results indicate that systematic data assessment and regular feedback is a feasible long-term strategy and may be linked to improved performance and a reduction in mortality in STEMI management.
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