Abstract TMP9: Hospitals' Performance on Timely Reperfusion in Stroke and Myocardial Infarction is not Correlated
Introduction: Timely reperfusion is performed less optimally in acute ischemic stroke (AIS) than in acute myocardial infarction (AMI). The degree to which hospital performance is correlated on emergent AMI and AIS care is unknown.
Hypothesis: There would be a positive correlation between hospital performance on door-to-balloon time (D2B) for AMI and door-to-needle time (DTN) for AIS; and hospital performance on D2B would predict DTN even after controlling for patient and hospital differences.
Methods: Prospective study of all hospitals participating in both Get With The Guidelines (GWTG)-Stroke and -Coronary Artery Disease from 2006-09 and treating ≥10 patients. We compared hospital-level DTN and D2B before and after risk adjustment using Spearman’s rank correlation coefficients and hierarchical linear regression modeling. We also correlated hospitals’ DTN and D2B data from 2013-14 using GWTG (DTN) and Hospital Compare (D2B).
Results: There were 43 hospitals contributing data (1976 AIS and 59,823 AMI patients). Hospitals’ DTN times for AIS did not correlate with their D2B times for AMI (median DTN 85 min [IQR 77-99] vs. median D2B 72 min [IQR 62-81]; ρ=-0.09; p=0.55). There was no correlation between hospitals’ proportion of eligible patients treated within target time windows for AIS and AMI (median DTN<60 minutes: 21% [IQR 11-30]; median D2B<90 minutes: 68% [IQR 62-79]; ρ=-0.14; p=0.36). The lack of correlation between hospitals’ DTN and D2B times persisted after risk adjustment. From 2013-14, hospitals’ DTN performance in GWTG was not correlated with D2B performance in Hospital Compare (N=546 hospitals; see figure).
Conclusions: We found no correlation between hospitals’ observed or risk-adjusted DTN and D2B times. Opportunities exist to improve hospitals’ performance of time-critical care processes for AIS and AMI in a coordinated rather than condition-specific manner.
Author Disclosures: K. Sauser-Zachrison: Research Grant; Modest; Get with the Guidelines-Stroke Young Investigator Database Research Seed Grant. D.A. Levine: None. G.C. Fonarow: Research Grant; Significant; Patient-Centered Outcomes Research Institute. M. Cox: None. A.D. DeVore: Research Grant; Modest; American Heart Association, Amgen, Maquet, Novartis, and Thoratec. E.E. Smith: None. R. Suter: Employment; Significant; American Heart Association. Y. Xian: Other Research Support; Modest; American Heart Association, Daiichi Sankyo, Janssen Pharmaceuticals, Genentech. D.L. Bhatt: Research Grant; Modest; Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company. L.H. Schwamm: Research Grant; Significant; NINDS and Genentech: PI of MR Witness trial of extended window, MR guided alteplase (NCT01282242) (significant) for which Genentech provides alteplase free of charge to MGH for distribution, as well a. Consultant/Advisory Board; Modest; Massachusetts Department of Public Health: Stroke systems consultant for the Paul Coverdell Acute Stroke Registry Grant. Other; Modest; Chair, Stroke Clinical Workgroup, AHA Get With The Guideline’s–Stroke program (unpaid).
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2016 by American Heart Association, Inc.