Is Door-to-Balloon Time a Misleading Metric?

July 2, 2015 - Door-to-balloon time is an integral process metric for measuring cardiovascular quality. Since its inclusion in the ACC/AHA Guidelines for STEMI management as a Class 1A recommendation,1 door-to-balloon time has evolved into a national quality metric. CMS began publicly reporting this measuer, and subsequently hospital performance has changed not only the practice of cardiology, but also the coordination of healh care devivery in acute care settings. However, as cardiovascular care has evolved, it becomes important to pause and consider whther door-to-balloon time as a metric in current practice has become misleading. 

Door-to-balloon time is an important cardiovascular process measure because it is both clinically meaningful and actionable. On a patient level, door-to-balloon time directly correlates with an amount of time the myocardium undergoes ischemic damage. Intuitively, reducing such time should reduce the degree of ischemic damage and ultimately improve patient outcomes. Indeed, in observiational studies, shorter door-to-balloon times for individual patients are associated with lower mortality in hospital, 2-4 at 30-days,5 and 1 year.6 

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Source: Butala N, Yeh RW, et al. Is Door-to-Balloon Time a Misleading Metric? American College of Cardiology. June 4, 2015.


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2. Rathore SS, Curtis JP, Chen J, et al. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study; 2009.

3. McNamara RL, Wang Y, Herrin J, et al. Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. Journal of the American College of Cardiology 2006;47:2180-6.

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6. Rathore SS, Curtis JP, Nallamothu BK, et al. Association of door-to-balloon time and mortality in patients > or =65 years with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. The American journal of cardiology 2009;104:1198-203.