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
See complete article at: http://www.acc.org/latest-in-cardiology/articles/2015/06/03/13/23/is-door-to-balloon-time-a-misleading-metric?w_nav=ACCUpdate&w_pub=ACCUpdate150612&WT.mc_ev=EmailOpen&sthash.5hRZcdwA.mjjo#sthash.5hRZcdwA.DX9Wq5qx.dpuf
Source: Butala N, Yeh RW, et al. Is Door-to-Balloon Time a Misleading Metric? American College of Cardiology. June 4, 2015.
References:
1. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation 2004;110:e82-292.
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.
4. Cannon CP, Gibson CM, Lambrew CT, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. Jama 2000;283:2941-7.
5. Berger PB, Ellis SG, Holmes DR, Jr., et al. Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: results from the global use of strategies to open occluded arteries in Acute Coronary Syndromes (GUSTO-IIb) trial. Circulation 1999;100:14-20.
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.
