Verbesserung der Herzinfarktversorgung durch standardisierte Datenerfassung und systematische Ergebnis-Rückkopplung

In patients with acute ST elevation myocardial infarction (STEMI) reperfusion with primary angioplasty is the preferred strategy. Many trials showed that extended revascularisation times probably lead to increased mortality. Current guidelines put emphasis on achieving rapid door-to-balloon- and contact-to-balloon times. In recent years a lot of effort has been put into improving treatment times. However only few hospitals meet this objective. The goal of the present study was to prospectively examine the proportion of patients who reach the requirements of the guidelines in "real-life" conditions; using the example of an optimized and well-established existing semi-rural cardiac network (transmitting a 12-lead ECG, bypassing the participating community hospitals in favor of the primary PCI centre and bypassing the PCI centre's emergency department with direct delivery of the patient to the cardiac catheterization laboratory). Furthermore the influence of standardized quality management, with formalized data feedback on treatment times, was analyzed. During a defined 12-month period, time points from initial contact with the medical system to revascularisation in patients with STEMI and primary PCI were prospectively assessed and quarterly analyzed. Within 17 days of the end of each quarter, an interactive session was conducted with the participation of all stakeholders involved in the AMI network. The data collected during the preceding quarter(s) were presented. Over the entire study period, median door-to-balloon time decreased from 54 min (1st quarter) to 26 min (4th quarter). Median contact-to-balloon time was 113 min in quarter 1 and was reduced to 74 min in quarter 4. Contact-to-balloon times <90min were achieved in 21% of patients in the first quarter; increasing to 79% in the fourth quarter. There was a marked increase in the proportion of primary transport patients who reached the catheterization laboratory directly without going through the emergency department (from 23% during the first quarter to 76% during the fourth quarter). In the present study times to treatment were already achieving international goals at baseline. However, the relatively simple intervention of systematic data feedback to the network participants led to a significant improvement of time delays. On the basis of a well organized and mandatory protocol for diagnosing, transporting and treating patients with STEMI, the proportion of patients with direct hand-off in cath-lab quarterly increased by involving quality measures. The present study represents the first prospective one worldwide which analyzes the additional effect of systematic data feedback on treatment times in patients with STEMI. Additionally, it is the first to show that extending the data feedback to emergency medical responders further reduces revascularization times and though improves process quality. To examine the effect of formalized data feedback on clinical outcome (e.g. mortality) in patients with STEMI, large multicenter studies are necessary. The multicenter FITT-STEMI project (Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction) is currently pursuing such an approach with the present study as pilot phase. The first aim of FITT-STEMI was to evaluate the transformability of the presented feedback concept in different clinical systems and regional STEMI networks. Furthermore, it was to demonstrate whether by including consistent web-based data collection, centralized data analysis, formalized data feedback and independent monitoring, sustainability of results can be achieved. First results showed that this feedback concept is feasible in different STEMI networks and independent of the respective existing different organization structures. In future FITT-STEMI is to show whether - including a risk stratification with the TIMI-Risk-Score- reducing of treatment times can improve prognosis.