Emergency department thrombolysis critical pathway reduces door-to-drug times in acute myocardial infarction

被引:23
作者
Cannon, CP
Johnson, EB
Cermignani, M
Scirica, BM
Sagarin, MJ
Walls, RM
机构
[1] Brigham & Womens Hosp, Div Cardiovasc, Dept Med, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] Queens Univ, Fac Med, Kingston, ON, Canada
[4] Brigham & Womens Hosp, Dept Emergency Med, Boston, MA USA
关键词
acute myocardial infarction; thrombolysis; time to treatment; gender;
D O I
10.1002/clc.4960220108
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Rapid time to treatment with thrombolytic therapy is an important determinant of survival in acute myocardial infarction (AMI). Hypothesis: We hypothesized that establishment of an AMI thrombolysis critical pathway in the Emergency Department could successfully reduce the "door-to-drug" time, the time between patient arrival and start of thrombolysis. Methods and results: Before establishment of the AMI critical pathway, median door-to-drug time was 73 min, which was reduced to 37 min after critical pathway implementation (p < 0.05). The percentage of patients treated within 30 min rose from 0% prior to establishment of the pathway to 43% (p = 0.03). Similarly, the percentage treated in within 45 min rose from 0 to 67% (p = 0.0005). Door-to-drug times were longer for women than for men (median 105 min for women vs. 70 min for men before pathway implementation). The pathway reduced door-to-drug time for both genders, but the median door-to-drug times were higher for women than for men (Mann-Whitney p = 0.013). The difference between men and women was 35 min before establishment of the pathway to 10 min by the end of the study period. Conclusions: Our critical pathway was successful in reducing door-to-drug times. We observed a "gender gap" in door-to-drug times, with longer mean times for women, which was reduced by the AMI critical pathway. Thus, our data provide support for the use of critical pathways to reduce door-to-drug times, as recommended by the National Heart Attack Alert Program.
引用
收藏
页码:17 / 20
页数:4
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