Scholz, Karl Heinrich and Lengenfelder, Bjoern and Jacobshagen, Claudius and Fleischmann, Claus and Moehlis, Hiller and Olbrich, Hans G. and Jung, Jens and Maier, Lars S. and Maier, Sebastian K. G. and Bestehorn, Kurt and Friede, Tim and Meyer, Thomas (2020) Long-term effects of a standardized feedback-driven quality improvement program for timely reperfusion therapy in regional STEMI care networks. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE. ISSN 2048-8726, 2048-8734
Full text not available from this repository. (Request a copy)Abstract
Aims: Current European Society of Cardiology guidelines state that repetitive monitoring and feedback should be implemented for ST-elevation myocardial infarction (STEMI) treatment, but no evidence is available supporting this recommendation. We aimed to analyze the long-term effects of a formalized data assessment and systematic feedback on performance and mortality within the prospective, multicenter Feedback Intervention and Treatment Times in STEMI (FITT-STEMI) study. Methods: Regular interactive feedback sessions with local STEMI management teams were performed at six participating German percutaneous coronary intervention (PCI) centers over a 10-year period starting from October 2007. Results: From the first to the 10th year of study participation, all predefined key-quality indicators for performance measurement used for feedback improved significantly in all 4926 consecutive PCI-treated patients - namely, the percentages of patients with pre-hospital electrocardiogram (ECG) recordings (83.3% vs 97.1%,p< 0.0001) and ECG recordings within 10 minutes after first medical contact (41.7% vs 63.8%,p< 0.0001), pre-announcement by telephone (77.0% vs 85.4%,p= 0.0007), direct transfer to the catheterization laboratory bypassing the emergency department (29.4% vs 64.2%,p< 0.0001), and contact-to-balloon times of less than 90 minutes (37.2% vs 53.7%,p< 0.0001). Moreover, this feedback-related continuous improvement of key-quality indicators was linked to a significant reduction in in-hospital mortality from 10.8% to 6.8% (p= 0.0244). Logistic regression models confirmed an independent beneficial effect of duration of study participation on hospital mortality (odds ratio = 0.986, 95% confidence interval = 0.976-0.996,p= 0.0087). In contrast, data from a nationwide PCI registry showed a continuous increase in in-hospital mortality in all PCI-treated STEMI patients in Germany from 2008 to 2015 (n= 398,027; 6.7% to 9.2%,p< 0.0001). Conclusions: Our results indicate that systematic data assessment and regular feedback is a feasible long-term strategy and may be linked to improved performance and a reduction in mortality in STEMI management.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ELEVATION MYOCARDIAL-INFARCTION; ST-SEGMENT-ELEVATION; TO-BALLOON TIME; PERCUTANEOUS CORONARY INTERVENTION; EMERGENCY-DEPARTMENT BYPASS; FORMALIZED DATA FEEDBACK; PRIMARY ANGIOPLASTY; FIELD TRIAGE; MORTALITY; MANAGEMENT; ST-segment elevation myocardial infarction (STEMI); percutaneous coronary intervention (PCI); feedback interventions; quality control measures; treatment times; mortality |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Petra Gürster |
| Date Deposited: | 14 Apr 2021 08:25 |
| Last Modified: | 14 Apr 2021 08:25 |
| URI: | https://pred.uni-regensburg.de/id/eprint/44143 |
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