Emergency Department Activation of Interventional Cardiology to Reduce Door-to-Balloon Time

BACKGROUND Despite American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, many hospitals have door-to-balloon times in excess of 90 minutes. Emergency Department (ED) activation of interventional cardiology has been described as an important strategy to reduce door-to-balloon time. However, prior studies on ED activation have been in suburban hospitals with door-to-balloon times near the ACC/AHA targeted times. OBJECTIVE To determine if ED activation of interventional cardiology could significantly improve reperfusion times and reach the ACC/AHA target of 90 minutes or less in a safety net hospital, a Level I trauma center and teaching hospital serving primarily uninsured and underinsured patient population with door-to-balloon times ranking in the lowest quartile of United States hospitals. METHODS In this study, door-to balloon times before and after implementation of ED activation were compared by retrospective chart review. RESULTS Eighty patients were included in the study, 48 before and 32 after ED activation of interventional cardiology. Median door-to-balloon time decreased from 163.5 minutes before to 130 minutes after ED activation, a significant difference of 33.5 minutes (p=0.028). Door-to-balloon time on nights, weekends and holidays decreased from a median of 165.5 minutes to 130 minutes, a reduction of 35.5 minutes, which also reached statistical significance (p=0.029). CONCLUSION ED activation of interventional cardiology produced a statistically significant reduction in door-to-balloon time. However, the reduction was not enough to achieve a door-to-balloon time of less than 90 minutes. Safety net hospitals with door-to-balloon times in the lowest quartile nationally may require multiple strategies to achieve targeted myocardial reperfusion times.