The Experts below are selected from a list of 136135332 Experts worldwide ranked by ideXlab platform

Harlan M Krumholz - One of the best experts on this subject based on the ideXlab platform.

  • Improvements in Door-to-Balloon Time in the United States, 2005 to 2010
    Circulation, 2011
    Co-Authors: Harlan M Krumholz, Elizabeth H Bradley, Brahmajee K Nallamothu, Jeph Herrin, Lauren E. Miller, Elizabeth E. Drye, Shari M. Ling, Lein F. Han, Michael T. Rapp, Wato Nsa
    Abstract:

    Background—Registry studies have suggested improvements in Door-to-Balloon times, but a national assessment of the trends in Door-to-Balloon times is lacking. Moreover, we do not know whether improvements in Door-to-Balloon times were shared equally among patient and hospital groups. Methods and Results—This analysis includes all patients reported by hospitals to the Centers for Medicare & Medicaid Services for inclusion in the time to percutaneous coronary intervention (acute myocardial infarction-8) inpatient measure from January 1, 2005, through September 30, 2010. For each calendar year, we summarized the characteristics of patients reported for the measure, including the number and percentage in each group, the median time to primary percutaneous coronary intervention, and the percentage with time to primary percutaneous coronary intervention within 75 minutes and within 90 minutes. Door-to-Balloon time declined from a median of 96 minutes in the year ending December 31, 2005, to a median of 64 minut...

  • Association of Door-to-Balloon Time and Mortality in Patients ≥65 Years With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
    The American journal of cardiology, 2009
    Co-Authors: Saif S Rathore, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Joanne M. Foody, Mikhail Kosiborod, Frederick A. Masoudi, Edward P. Havranek, Harlan M Krumholz
    Abstract:

    Current guidelines recommend patients with ST-elevation myocardial infarction receive primary percutaneous coronary intervention (PCI) within 90 minutes of admission, although there are conflicting data regarding the relation between time to treatment and mortality in these patients. We used logistic regression analyses employing a fractional polynomial model to evaluate the association between Door-to-Balloon time and 1-year mortality in patients with ST-elevation myocardial infarction ≥65 years old undergoing primary PCI from 1994 to 1996 (n = 1,932). Median Door-to-Balloon time was 128 minutes (interquartile range 92 to 178, 24.2% treated within 90 minutes). Overall 1-year mortality was 21.1%. Longer Door-to-Balloon times were associated with higher 1-year mortality in a continuous, nonlinear fashion (30 minutes 10.9%, 60 minutes 13.6%, 90 minutes 16.5%, 120 minutes 19.5%, 150 minutes 22.5%, 180 minutes 25.3%, 210 minutes 27.9%). The nature of the association between Door-to-Balloon time and 1-year mortality was best modeled by a second-degree fractional polynomial (p

  • association of door to balloon time and mortality in patients admitted to hospital with st elevation myocardial infarction national cohort study
    BMJ, 2009
    Co-Authors: Saif S Rathore, Andrew J Epstein, Jersey Chen, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Harlan M Krumholz
    Abstract:

    Objective To evaluate the association between Door-to-Balloon time and mortality in hospital in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction to assess the incremental mortality benefit of reductions in Door-to-Balloon times of less than 90 minutes. Design Prospective cohort study of patients enrolled in the American College of Cardiology National Cardiovascular Data Registry, 2005-6. Setting Acute care hospitals. Participants 43 801 patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Main outcome measure Mortality in hospital. Results Median Door-to-Balloon time was 83 minutes (interquartile range 6-109, 57.9% treated within 90 minutes). Overall mortality in hospital was 4.6%. Multivariable logistic regression models with fractional polynomial models indicated that longer Door-to-Balloon times were associated with a higher adjusted risk of mortality in hospital in a continuous non-linear fashion (30 minutes=3.0%, 60 minutes=3.5%, 90 minutes=4.3%, 120 minutes=5.6%, 150 minutes=7.0%, 180 minutes=8.4%, P Conclusion Any delay in primary percutaneous coronary intervention after a patient arrives at hospital is associated with higher mortality in hospital in those admitted with ST elevation myocardial infarction. Time to treatment should be as short as possible, even in centres currently providing primary percutaneous coronary intervention within 90 minutes.

  • Reducing Door-to-Balloon Times: The Transfer Factor
    NEJM Journal Watch, 2008
    Co-Authors: Harlan M Krumholz
    Abstract:

    Recent articles have focused attention on strategies to reduce Door-to-Balloon times for patients with ST-segment-elevation MI (STEMI) who undergo

  • time to treatment in primary percutaneous coronary intervention
    The New England Journal of Medicine, 2007
    Co-Authors: Brahmajee K Nallamothu, Elizabeth H Bradley, Harlan M Krumholz
    Abstract:

    Early administration of reperfusion therapy improves survival among patients with ST-elevation myocardial infarction. For primary percutaneous intervention, a goal of 90 minutes or less for Door-to-Balloon time is incorporated into many measures of quality performance, but delay remains common, with little improvement in this measure over recent years. This review examines the strategies for reducing Door-to-Balloon time and for selecting the appropriate reperfusion therapy, especially when a delay is unavoidable.

Brahmajee K Nallamothu - One of the best experts on this subject based on the ideXlab platform.

  • Coronary intervention Door-to-Balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis.
    Heart (British Cardiac Society), 2018
    Co-Authors: Chee Yoong Foo, Brahmajee K Nallamothu, Kwadwo Osei Bonsu, Christopher M. Reid, Teerapon Dhippayom, Daniel D. Reidpath, Nathorn Chaiyakunapruk
    Abstract:

    Objective This study aims to determine the relationship between Door-to-Balloon delay in primary percutaneous coronary intervention and ST-elevation myocardial infarction (MI) outcomes and examine for potential effect modifiers. Methods We conducted a systematic review and meta-analysis of prospective observational studies that have investigated the relationship of Door-to-Balloon delay and clinical outcomes. The main outcomes include mortality and heart failure. Results 32 studies involving 299 320 patients contained adequate data for quantitative reporting. Patients with ST-elevation MI who experienced longer (>90 min) Door-to-Balloon delay had a higher risk of short-term mortality (pooled OR 1.52, 95% CI 1.40 to 1.65) and medium-term to long-term mortality (pooled OR 1.53, 95% CI 1.13 to 2.06). A non-linear time – risk relation was observed (P=0.004 for non-linearity). The association between longer Door-to-Balloon delay and short-term mortality differed between those presented early and late after symptom onset (Cochran’s Q 3.88, P value 0.049) with a stronger relationship among those with shorter prehospital delays. Conclusion Longer Door-to-Balloon delay in primary percutaneous coronary intervention for ST-elevation MI is related to higher risk of adverse outcomes. Prehospital delays modified this effect. The non-linearity of the time – risk relation might explain the lack of population effect despite an improved Door-to-Balloon time in the USA. Clinical trial registration PROSPERO (CRD42015026069).

  • Improvements in Door-to-Balloon Time in the United States, 2005 to 2010
    Circulation, 2011
    Co-Authors: Harlan M Krumholz, Elizabeth H Bradley, Brahmajee K Nallamothu, Jeph Herrin, Lauren E. Miller, Elizabeth E. Drye, Shari M. Ling, Lein F. Han, Michael T. Rapp, Wato Nsa
    Abstract:

    Background—Registry studies have suggested improvements in Door-to-Balloon times, but a national assessment of the trends in Door-to-Balloon times is lacking. Moreover, we do not know whether improvements in Door-to-Balloon times were shared equally among patient and hospital groups. Methods and Results—This analysis includes all patients reported by hospitals to the Centers for Medicare & Medicaid Services for inclusion in the time to percutaneous coronary intervention (acute myocardial infarction-8) inpatient measure from January 1, 2005, through September 30, 2010. For each calendar year, we summarized the characteristics of patients reported for the measure, including the number and percentage in each group, the median time to primary percutaneous coronary intervention, and the percentage with time to primary percutaneous coronary intervention within 75 minutes and within 90 minutes. Door-to-Balloon time declined from a median of 96 minutes in the year ending December 31, 2005, to a median of 64 minut...

  • National Efforts to Improve Door-to-Balloon Time: Results From the Door-to-Balloon Alliance
    Journal of the American College of Cardiology, 2009
    Co-Authors: Elizabeth H Bradley, Brahmajee K Nallamothu, Jeph Herrin, Henry H. Ting, Amy F. Stern, Ingrid M. Nembhard, Christina T. Yuan, Jeremy C. Green, Eva Kline-rogers, Yongfei Wang
    Abstract:

    Objectives The purpose of this study was to determine if enrollment in the Door-to-Balloon (D2B) Alliance, a national quality campaign sponsored by the American College of Cardiology and 38 partner organizations, was associated with increased likelihood of patients who received primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) being treated within 90 min of hospital presentation. Background The D2B Alliance, launched in November 2006, sought to achieve the goal of having 75% of patients with STEMI treated within 90 min of hospital presentation. Methods We conducted a longitudinal study of D2B times in 831 hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry, April 1, 2005, to March 31, 2008. Results By March 2008, >75% of patients had D2B times of ≤90 min, compared with only about one-half of patients with D2B times within 90 min in April 2005. Trends since the launch of the D2B Alliance showed that patients treated in hospitals enrolled in the D2B Alliance for at least 3 months were significantly more likely than patients treated in nonenrolled hospitals to have D2B times within 90 min, although the magnitude of the difference was modest (odds ratio: 1.16; 95% confidence interval: 1.07 to 1.27). Conclusions The D2B Alliance reached its goal of 75% of patients with STEMI having D2B times within 90 min by 2008.

  • Association of Door-to-Balloon Time and Mortality in Patients ≥65 Years With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
    The American journal of cardiology, 2009
    Co-Authors: Saif S Rathore, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Joanne M. Foody, Mikhail Kosiborod, Frederick A. Masoudi, Edward P. Havranek, Harlan M Krumholz
    Abstract:

    Current guidelines recommend patients with ST-elevation myocardial infarction receive primary percutaneous coronary intervention (PCI) within 90 minutes of admission, although there are conflicting data regarding the relation between time to treatment and mortality in these patients. We used logistic regression analyses employing a fractional polynomial model to evaluate the association between Door-to-Balloon time and 1-year mortality in patients with ST-elevation myocardial infarction ≥65 years old undergoing primary PCI from 1994 to 1996 (n = 1,932). Median Door-to-Balloon time was 128 minutes (interquartile range 92 to 178, 24.2% treated within 90 minutes). Overall 1-year mortality was 21.1%. Longer Door-to-Balloon times were associated with higher 1-year mortality in a continuous, nonlinear fashion (30 minutes 10.9%, 60 minutes 13.6%, 90 minutes 16.5%, 120 minutes 19.5%, 150 minutes 22.5%, 180 minutes 25.3%, 210 minutes 27.9%). The nature of the association between Door-to-Balloon time and 1-year mortality was best modeled by a second-degree fractional polynomial (p

  • association of door to balloon time and mortality in patients admitted to hospital with st elevation myocardial infarction national cohort study
    BMJ, 2009
    Co-Authors: Saif S Rathore, Andrew J Epstein, Jersey Chen, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Harlan M Krumholz
    Abstract:

    Objective To evaluate the association between Door-to-Balloon time and mortality in hospital in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction to assess the incremental mortality benefit of reductions in Door-to-Balloon times of less than 90 minutes. Design Prospective cohort study of patients enrolled in the American College of Cardiology National Cardiovascular Data Registry, 2005-6. Setting Acute care hospitals. Participants 43 801 patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Main outcome measure Mortality in hospital. Results Median Door-to-Balloon time was 83 minutes (interquartile range 6-109, 57.9% treated within 90 minutes). Overall mortality in hospital was 4.6%. Multivariable logistic regression models with fractional polynomial models indicated that longer Door-to-Balloon times were associated with a higher adjusted risk of mortality in hospital in a continuous non-linear fashion (30 minutes=3.0%, 60 minutes=3.5%, 90 minutes=4.3%, 120 minutes=5.6%, 150 minutes=7.0%, 180 minutes=8.4%, P Conclusion Any delay in primary percutaneous coronary intervention after a patient arrives at hospital is associated with higher mortality in hospital in those admitted with ST elevation myocardial infarction. Time to treatment should be as short as possible, even in centres currently providing primary percutaneous coronary intervention within 90 minutes.

Elizabeth H Bradley - One of the best experts on this subject based on the ideXlab platform.

  • Improvements in Door-to-Balloon Time in the United States, 2005 to 2010
    Circulation, 2011
    Co-Authors: Harlan M Krumholz, Elizabeth H Bradley, Brahmajee K Nallamothu, Jeph Herrin, Lauren E. Miller, Elizabeth E. Drye, Shari M. Ling, Lein F. Han, Michael T. Rapp, Wato Nsa
    Abstract:

    Background—Registry studies have suggested improvements in Door-to-Balloon times, but a national assessment of the trends in Door-to-Balloon times is lacking. Moreover, we do not know whether improvements in Door-to-Balloon times were shared equally among patient and hospital groups. Methods and Results—This analysis includes all patients reported by hospitals to the Centers for Medicare & Medicaid Services for inclusion in the time to percutaneous coronary intervention (acute myocardial infarction-8) inpatient measure from January 1, 2005, through September 30, 2010. For each calendar year, we summarized the characteristics of patients reported for the measure, including the number and percentage in each group, the median time to primary percutaneous coronary intervention, and the percentage with time to primary percutaneous coronary intervention within 75 minutes and within 90 minutes. Door-to-Balloon time declined from a median of 96 minutes in the year ending December 31, 2005, to a median of 64 minut...

  • National Efforts to Improve Door-to-Balloon Time: Results From the Door-to-Balloon Alliance
    Journal of the American College of Cardiology, 2009
    Co-Authors: Elizabeth H Bradley, Brahmajee K Nallamothu, Jeph Herrin, Henry H. Ting, Amy F. Stern, Ingrid M. Nembhard, Christina T. Yuan, Jeremy C. Green, Eva Kline-rogers, Yongfei Wang
    Abstract:

    Objectives The purpose of this study was to determine if enrollment in the Door-to-Balloon (D2B) Alliance, a national quality campaign sponsored by the American College of Cardiology and 38 partner organizations, was associated with increased likelihood of patients who received primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) being treated within 90 min of hospital presentation. Background The D2B Alliance, launched in November 2006, sought to achieve the goal of having 75% of patients with STEMI treated within 90 min of hospital presentation. Methods We conducted a longitudinal study of D2B times in 831 hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry, April 1, 2005, to March 31, 2008. Results By March 2008, >75% of patients had D2B times of ≤90 min, compared with only about one-half of patients with D2B times within 90 min in April 2005. Trends since the launch of the D2B Alliance showed that patients treated in hospitals enrolled in the D2B Alliance for at least 3 months were significantly more likely than patients treated in nonenrolled hospitals to have D2B times within 90 min, although the magnitude of the difference was modest (odds ratio: 1.16; 95% confidence interval: 1.07 to 1.27). Conclusions The D2B Alliance reached its goal of 75% of patients with STEMI having D2B times within 90 min by 2008.

  • time to treatment in primary percutaneous coronary intervention
    The New England Journal of Medicine, 2007
    Co-Authors: Brahmajee K Nallamothu, Elizabeth H Bradley, Harlan M Krumholz
    Abstract:

    Early administration of reperfusion therapy improves survival among patients with ST-elevation myocardial infarction. For primary percutaneous intervention, a goal of 90 minutes or less for Door-to-Balloon time is incorporated into many measures of quality performance, but delay remains common, with little improvement in this measure over recent years. This review examines the strategies for reducing Door-to-Balloon time and for selecting the appropriate reperfusion therapy, especially when a delay is unavoidable.

  • Summary of evidence regarding hospital strategies to reduce Door-to-Balloon times for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
    Critical pathways in cardiology, 2007
    Co-Authors: Elizabeth H Bradley, Jeptha P Curtis, Brahmajee K Nallamothu, David J. Magid, Tashonna R Webster, Christopher B. Granger, Mauro Moscucci, Harlan M Krumholz
    Abstract:

    Despite the clinical importance of prompt percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction, many hospitals do not routinely achieve the guideline-recommended 90-minute Door-to-Balloon times. In this review, we evaluate existing evidence that identifies effective hospital strategies for reducing Door-to-Balloon time. We performed a computerized search of MEDLINE and Current Contents for studies conducted in the last 10 years of hospital efforts to improve Door-to-Balloon times. We excluded studies that had

  • strategies for reducing the door to balloon time in acute myocardial infarction
    The New England Journal of Medicine, 2006
    Co-Authors: Elizabeth H Bradley, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Jeph Herrin, Barbara A Barton, Tashonna R Webster, Jennifer A Mattera, Sarah A Roumanis, David J. Magid
    Abstract:

    Background Prompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (Door-to-Balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, few hospitals meet this objective. We sought to identify hospital strategies that were significantly associated with a faster Door-to-Balloon time. Methods We surveyed 365 hospitals to determine whether each of 28 specific strategies was in use. We used hierarchical generalized linear models and data on patients from the Centers for Medicare and Medicaid Services to determine the association between hospital strategies and the Door-to-Balloon time. Results In multivariate analysis, six strategies were significantly associated with a faster Door-to-Balloon time. These strategies included having emergency medicine physicians activate the catheterization laboratory (mean ...

Yongfei Wang - One of the best experts on this subject based on the ideXlab platform.

  • Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI
    The New England journal of medicine, 2013
    Co-Authors: Daniel S. Menees, Jeptha P Curtis, Yongfei Wang, Eric D Peterson, John C. Messenger, John S. Rumsfeld, Hitinder S. Gurm
    Abstract:

    Background Current guidelines for the treatment of ST-segment elevation myocardial infarction recommend a Door-to-Balloon time of 90 minutes or less for patients undergoing primary percutaneous coronary intervention (PCI). Door-to-Balloon time has become a performance measure and is the focus of regional and national quality-improvement initiatives. However, it is not known whether national improvements in Door-to-Balloon times have been accompanied by a decline in mortality. Methods We analyzed annual trends in Door-to-Balloon times and in-hospital mortality using data from 96,738 admissions for patients undergoing primary PCI for ST-segment elevation myocardial infarction from July 2005 through June 2009 at 515 hospitals participating in the CathPCI Registry. In a subgroup analysis using a linked Medicare data set, we assessed 30-day mortality. Results Median Door-to-Balloon times declined significantly, from 83 minutes in the 12 months from July 2005 through June 2006 to 67 minutes in the 12 months fro...

  • National Efforts to Improve Door-to-Balloon Time: Results From the Door-to-Balloon Alliance
    Journal of the American College of Cardiology, 2009
    Co-Authors: Elizabeth H Bradley, Brahmajee K Nallamothu, Jeph Herrin, Henry H. Ting, Amy F. Stern, Ingrid M. Nembhard, Christina T. Yuan, Jeremy C. Green, Eva Kline-rogers, Yongfei Wang
    Abstract:

    Objectives The purpose of this study was to determine if enrollment in the Door-to-Balloon (D2B) Alliance, a national quality campaign sponsored by the American College of Cardiology and 38 partner organizations, was associated with increased likelihood of patients who received primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) being treated within 90 min of hospital presentation. Background The D2B Alliance, launched in November 2006, sought to achieve the goal of having 75% of patients with STEMI treated within 90 min of hospital presentation. Methods We conducted a longitudinal study of D2B times in 831 hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry, April 1, 2005, to March 31, 2008. Results By March 2008, >75% of patients had D2B times of ≤90 min, compared with only about one-half of patients with D2B times within 90 min in April 2005. Trends since the launch of the D2B Alliance showed that patients treated in hospitals enrolled in the D2B Alliance for at least 3 months were significantly more likely than patients treated in nonenrolled hospitals to have D2B times within 90 min, although the magnitude of the difference was modest (odds ratio: 1.16; 95% confidence interval: 1.07 to 1.27). Conclusions The D2B Alliance reached its goal of 75% of patients with STEMI having D2B times within 90 min by 2008.

  • Association of Door-to-Balloon Time and Mortality in Patients ≥65 Years With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
    The American journal of cardiology, 2009
    Co-Authors: Saif S Rathore, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Joanne M. Foody, Mikhail Kosiborod, Frederick A. Masoudi, Edward P. Havranek, Harlan M Krumholz
    Abstract:

    Current guidelines recommend patients with ST-elevation myocardial infarction receive primary percutaneous coronary intervention (PCI) within 90 minutes of admission, although there are conflicting data regarding the relation between time to treatment and mortality in these patients. We used logistic regression analyses employing a fractional polynomial model to evaluate the association between Door-to-Balloon time and 1-year mortality in patients with ST-elevation myocardial infarction ≥65 years old undergoing primary PCI from 1994 to 1996 (n = 1,932). Median Door-to-Balloon time was 128 minutes (interquartile range 92 to 178, 24.2% treated within 90 minutes). Overall 1-year mortality was 21.1%. Longer Door-to-Balloon times were associated with higher 1-year mortality in a continuous, nonlinear fashion (30 minutes 10.9%, 60 minutes 13.6%, 90 minutes 16.5%, 120 minutes 19.5%, 150 minutes 22.5%, 180 minutes 25.3%, 210 minutes 27.9%). The nature of the association between Door-to-Balloon time and 1-year mortality was best modeled by a second-degree fractional polynomial (p

  • association of door to balloon time and mortality in patients admitted to hospital with st elevation myocardial infarction national cohort study
    BMJ, 2009
    Co-Authors: Saif S Rathore, Andrew J Epstein, Jersey Chen, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Harlan M Krumholz
    Abstract:

    Objective To evaluate the association between Door-to-Balloon time and mortality in hospital in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction to assess the incremental mortality benefit of reductions in Door-to-Balloon times of less than 90 minutes. Design Prospective cohort study of patients enrolled in the American College of Cardiology National Cardiovascular Data Registry, 2005-6. Setting Acute care hospitals. Participants 43 801 patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Main outcome measure Mortality in hospital. Results Median Door-to-Balloon time was 83 minutes (interquartile range 6-109, 57.9% treated within 90 minutes). Overall mortality in hospital was 4.6%. Multivariable logistic regression models with fractional polynomial models indicated that longer Door-to-Balloon times were associated with a higher adjusted risk of mortality in hospital in a continuous non-linear fashion (30 minutes=3.0%, 60 minutes=3.5%, 90 minutes=4.3%, 120 minutes=5.6%, 150 minutes=7.0%, 180 minutes=8.4%, P Conclusion Any delay in primary percutaneous coronary intervention after a patient arrives at hospital is associated with higher mortality in hospital in those admitted with ST elevation myocardial infarction. Time to treatment should be as short as possible, even in centres currently providing primary percutaneous coronary intervention within 90 minutes.

  • strategies for reducing the door to balloon time in acute myocardial infarction
    The New England Journal of Medicine, 2006
    Co-Authors: Elizabeth H Bradley, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Jeph Herrin, Barbara A Barton, Tashonna R Webster, Jennifer A Mattera, Sarah A Roumanis, David J. Magid
    Abstract:

    Background Prompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (Door-to-Balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, few hospitals meet this objective. We sought to identify hospital strategies that were significantly associated with a faster Door-to-Balloon time. Methods We surveyed 365 hospitals to determine whether each of 28 specific strategies was in use. We used hierarchical generalized linear models and data on patients from the Centers for Medicare and Medicaid Services to determine the association between hospital strategies and the Door-to-Balloon time. Results In multivariate analysis, six strategies were significantly associated with a faster Door-to-Balloon time. These strategies included having emergency medicine physicians activate the catheterization laboratory (mean ...

Jeptha P Curtis - One of the best experts on this subject based on the ideXlab platform.

  • Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI
    The New England journal of medicine, 2013
    Co-Authors: Daniel S. Menees, Jeptha P Curtis, Yongfei Wang, Eric D Peterson, John C. Messenger, John S. Rumsfeld, Hitinder S. Gurm
    Abstract:

    Background Current guidelines for the treatment of ST-segment elevation myocardial infarction recommend a Door-to-Balloon time of 90 minutes or less for patients undergoing primary percutaneous coronary intervention (PCI). Door-to-Balloon time has become a performance measure and is the focus of regional and national quality-improvement initiatives. However, it is not known whether national improvements in Door-to-Balloon times have been accompanied by a decline in mortality. Methods We analyzed annual trends in Door-to-Balloon times and in-hospital mortality using data from 96,738 admissions for patients undergoing primary PCI for ST-segment elevation myocardial infarction from July 2005 through June 2009 at 515 hospitals participating in the CathPCI Registry. In a subgroup analysis using a linked Medicare data set, we assessed 30-day mortality. Results Median Door-to-Balloon times declined significantly, from 83 minutes in the 12 months from July 2005 through June 2006 to 67 minutes in the 12 months fro...

  • Association of Door-to-Balloon Time and Mortality in Patients ≥65 Years With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
    The American journal of cardiology, 2009
    Co-Authors: Saif S Rathore, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Joanne M. Foody, Mikhail Kosiborod, Frederick A. Masoudi, Edward P. Havranek, Harlan M Krumholz
    Abstract:

    Current guidelines recommend patients with ST-elevation myocardial infarction receive primary percutaneous coronary intervention (PCI) within 90 minutes of admission, although there are conflicting data regarding the relation between time to treatment and mortality in these patients. We used logistic regression analyses employing a fractional polynomial model to evaluate the association between Door-to-Balloon time and 1-year mortality in patients with ST-elevation myocardial infarction ≥65 years old undergoing primary PCI from 1994 to 1996 (n = 1,932). Median Door-to-Balloon time was 128 minutes (interquartile range 92 to 178, 24.2% treated within 90 minutes). Overall 1-year mortality was 21.1%. Longer Door-to-Balloon times were associated with higher 1-year mortality in a continuous, nonlinear fashion (30 minutes 10.9%, 60 minutes 13.6%, 90 minutes 16.5%, 120 minutes 19.5%, 150 minutes 22.5%, 180 minutes 25.3%, 210 minutes 27.9%). The nature of the association between Door-to-Balloon time and 1-year mortality was best modeled by a second-degree fractional polynomial (p

  • association of door to balloon time and mortality in patients admitted to hospital with st elevation myocardial infarction national cohort study
    BMJ, 2009
    Co-Authors: Saif S Rathore, Andrew J Epstein, Jersey Chen, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Harlan M Krumholz
    Abstract:

    Objective To evaluate the association between Door-to-Balloon time and mortality in hospital in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction to assess the incremental mortality benefit of reductions in Door-to-Balloon times of less than 90 minutes. Design Prospective cohort study of patients enrolled in the American College of Cardiology National Cardiovascular Data Registry, 2005-6. Setting Acute care hospitals. Participants 43 801 patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Main outcome measure Mortality in hospital. Results Median Door-to-Balloon time was 83 minutes (interquartile range 6-109, 57.9% treated within 90 minutes). Overall mortality in hospital was 4.6%. Multivariable logistic regression models with fractional polynomial models indicated that longer Door-to-Balloon times were associated with a higher adjusted risk of mortality in hospital in a continuous non-linear fashion (30 minutes=3.0%, 60 minutes=3.5%, 90 minutes=4.3%, 120 minutes=5.6%, 150 minutes=7.0%, 180 minutes=8.4%, P Conclusion Any delay in primary percutaneous coronary intervention after a patient arrives at hospital is associated with higher mortality in hospital in those admitted with ST elevation myocardial infarction. Time to treatment should be as short as possible, even in centres currently providing primary percutaneous coronary intervention within 90 minutes.

  • Summary of evidence regarding hospital strategies to reduce Door-to-Balloon times for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
    Critical pathways in cardiology, 2007
    Co-Authors: Elizabeth H Bradley, Jeptha P Curtis, Brahmajee K Nallamothu, David J. Magid, Tashonna R Webster, Christopher B. Granger, Mauro Moscucci, Harlan M Krumholz
    Abstract:

    Despite the clinical importance of prompt percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction, many hospitals do not routinely achieve the guideline-recommended 90-minute Door-to-Balloon times. In this review, we evaluate existing evidence that identifies effective hospital strategies for reducing Door-to-Balloon time. We performed a computerized search of MEDLINE and Current Contents for studies conducted in the last 10 years of hospital efforts to improve Door-to-Balloon times. We excluded studies that had

  • strategies for reducing the door to balloon time in acute myocardial infarction
    The New England Journal of Medicine, 2006
    Co-Authors: Elizabeth H Bradley, Jeptha P Curtis, Yongfei Wang, Brahmajee K Nallamothu, Jeph Herrin, Barbara A Barton, Tashonna R Webster, Jennifer A Mattera, Sarah A Roumanis, David J. Magid
    Abstract:

    Background Prompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (Door-to-Balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, few hospitals meet this objective. We sought to identify hospital strategies that were significantly associated with a faster Door-to-Balloon time. Methods We surveyed 365 hospitals to determine whether each of 28 specific strategies was in use. We used hierarchical generalized linear models and data on patients from the Centers for Medicare and Medicaid Services to determine the association between hospital strategies and the Door-to-Balloon time. Results In multivariate analysis, six strategies were significantly associated with a faster Door-to-Balloon time. These strategies included having emergency medicine physicians activate the catheterization laboratory (mean ...