Karl Heinrich Scholz1, Björn Lengenfelder2,3, Claudius Jacobshagen4, Claus Fleischmann5, Hiller Moehlis6, Hans G Olbrich7, Jens Jung8, Lars S Maier9, Sebastian Kg Maier3,10, Kurt Bestehorn11, Tim Friede12,13, Thomas Meyer13,14. 1. Department of Cardiology, St Bernward Hospital, Hildesheim, Germany. 2. Department of Cardiology, University of Würzburg, Germany. 3. Comprehensive Heart Failure Center Würzburg, Würzburg, Germany. 4. Department of Cardiology, Heart Center, University of Göttingen, Göttingen, Germany. 5. Department of Cardiology, Klinikum Wolfsburg, Wolfsburg, Germany. 6. Department of Cardiology, Klinikum Darmstadt, Darmstadt, Germany. 7. Department of Cardiology, Asklepios Klinik Langen, Langen, Germany. 8. Department of Cardiology, Klinikum Worms, Worms, Germany. 9. Department of Cardiology, University Hospital Regensburg, Regensburg, Germany. 10. Department of Cardiology, Klinikum Straubing, Straubing, Germany. 11. Institute for Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany. 12. Department of Medical Statistics, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany. 13. German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany. 14. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany.
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.
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.
Entities:
Keywords:
ST-segment elevation myocardial infarction (STEMI); feedback interventions; mortality; percutaneous coronary intervention (PCI); quality control measures; treatment times
Authors: Alessandra Batista Teixeira; Leonardo Fiaschi Zancaner; Fernando Fonseca de França Ribeiro; José Paulo Pintyá; André Schmidt; Benedito Carlos Maciel; José Antônio Marin Neto; Carlos Henrique Miranda Journal: Arq Bras Cardiol Date: 2022-03 Impact factor: 2.000