BOSTON — A statewide program to get patients with severe heart attacks to hospitals faster significantly reduced disparities in reperfusion treatment times for women and elderly patients, based on a study of more than 900 patients in North Carolina.
Disparities exist in the use and timing of reperfusion therapy for ST-segment elevation myocardial infarction (STEMI), Dr. Seth Glickman said at the annual meeting of the American College of Emergency Physicians. “Recent national efforts have focused on the regionalization of STEMI care to reduce time to reperfusion,” he noted.
The impact of regionalization on STEMI care for hospitals that don't provide percutaneous coronary intervention (PCI) is unknown, but studies have shown that middle-aged white patients are more likely to benefit than other demographic groups, said Dr. Glickman of the University of North Carolina, Chapel Hill.
In the study, Dr. Glickman and colleagues reviewed data from 923 patients treated at 55 hospitals without PCI services during the Reperfusion of Acute Myocardial Infarction of North Carolina Emergency Departments (RACE) initiative from 2005 to 2007.
The RACE program divided the state of North Carolina into five regions, with at least one PCI-capable hospital in each region. The investigators compared 518 patients treated prior to the RACE initiative and 405 patients treated after the initiative. The patients ranged in age from 51 to 73 years.
Overall, median door-to-ECG times before and after RACE dropped from 10 minutes to 8 minutes in men, and from 15 minutes to 8 minutes in women.
The median door in/door out times for men dropped from 85 minutes to 55 minutes, and times for women dropped from 124 minutes to 65 minutes. Median door-to-needle times decreased from 33 minutes to 29 minutes in men, and from 42 minutes to 30 minutes for women. Before the intervention, women's times were significantly longer than men's. After the intervention, however, the times for both genders were nearly identical, Dr. Glickman noted.
There was a slight increase in the use of prehospital ECG as part of the RACE initiative, he added.
The median door-to-ECG time for patients younger than 70 years dropped from 10 minutes to 7 minutes before and after RACE, and the time for patients 70 and older dropped from 18 minutes to 9 minutes.
Median door in/door out times for patients younger than 70 years dropped from 81 minutes to 48 minutes, and times for patients 70 years and older dropped from 117 minutes to 76 minutes. Median door-to-needle times for patients younger than 70 years dropped from 32 minutes to 28 minutes, and from 48 minutes to 36 minutes for patients aged 70 years and older.
The results were limited by a lack of regional comparators during the study period, but the findings showed a reduction in baseline care disparities between men and women, Dr. Glickman said. Disparities persist in the elderly, despite improvements after the RACE initiative, Dr. Glickman noted, which suggests the need for additional study and intervention focused on older patients.
The research was supported by the American Heart Association, the Robert Wood Johnson Foundation, and Blue Cross Blue Shield of North Carolina. For more details on RACE, visit www.nccacc.org/race.html
To watch a video interview with Dr. Glickman, go to www.youtube.com/user/FamilyPracticeNews#p/a/u/0/oZ_aXx-8kqU