NEW YORK NURSE: April 2011
Why haven’t door-to-balloon campaigns improved acute myocardial infarctions (MI) outcomes?
The time from “door-to-balloon,” according to the American Heart Association definition, is the amount of time between when a heart attack patient arrives at the hospital to the time he/she receives a percutaneous coronary intervention (PCI), such as angioplasty. Significant improvements have been realized in the treatment of acute myocardial infarctions (MI) through the use of thrombolytic therapy and primary angioplasty, however, the benefits of treatment are realized only when treatment occurs within less than 90 minutes from the onset of symptoms.
The majority of MI deaths occur within the first hour after symptom onset however, 50 percent of those with an acute MI delay treatment for six hours or more and fewer than 50 percent are transferred to the hospital by EMS personnel that can provide defibrillation.1
Delays in reperfusion occur at any one of four points: the decision to seek medical treatment, the first medical contact, hospital arrival, and definitive treatment. Door-to-balloon campaigns have reduced delays at the first medical contact but delays in the decision to seek medical care average 4.7 hours when the goal is 5 minutes.2
Factors affecting such delays include: co-morbidities, older age, female gender, minority status, living alone, presence of family members, onset of symptoms while at rest, fear of embarrassment, lack of education, low literacy skills, and providers that do not recommend calling 911.3
1 Disparities in adult awareness of heart attack warning signs and symptoms— 14 states, 2005. (2008). MMWR, 57(7), 175-179.
2 Laifer, L. (2011). Current paradigms and ongoing challenges in the treatment of acute myocardial infarction. [PowerPoint slides]
3 Sullivan, M.D., et al., (2009). Understanding why patients delay seeking care for acute coronary syndromes. Circulation: Cardiovascular Quality and Outcomes. 2, 148-154.