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Despite successful efforts by hospitals to reduce door-to-balloon times for heart attack patients, a study published in the New England Journal of Medicine finds that shorter times did not affect mortality rates.
The analysis of around 97,000 admissions for primary percutaneous coronary intervention found that door-to-balloon times for the patients dropped by an average of 16 minutes – from 83 minutes July 2005-June 2006 to 67 minutes from July 2008-June 2009. But the average mortality rate dropped to 4.7% from 5% after the improved treatment times – an insignificant drop. The change was also insignificant for 30-day mortality in Medicare patients.
While efforts to drop heart attack treatment times have been successful and commendable, researchers are puzzled as to the mortality rates. One study author suggests that patients sometimes do not recognize their symptoms and don’t immediately seek help. Another study co-author states that other unintended consequences may occur, such as physicians being in such a rush to get through the 90-minute deadline that patients who don’t need the balloon or stent treatment may be sent to the cath lab, delaying proper diagnosis and treatment.
But that’s not to say that there is no success in cutting door-to-balloon times. The study showed that mortality rates were double for patients who did not get treatment within 90 minutes of arrival.
With these findings, the researchers question using door-to-balloon times as the main focus of performance measurement and reporting. “These data suggest that additional strategies are needed to reduce in-hospital mortality in this population,” they said in the conclusions.