Good door-to-balloon time not associated with fast stroke response, study finds

Overall the hospitals were significantly better at meeting door-to-balloon time goals than those for door-to-needle time and performance ranged more widely among hospitals on the latter measure.


There was no correlation between door-to-balloon time for ST-segment–elevation myocardial infarction (STEMI) and door-to-needle time for acute ischemic stroke among hospitals participating in the Get With The Guidelines (GWTG) programs, a recent study found.

The prospective study included all 43 hospitals that were participating in both GWTG-Stroke and GWTG-Coronary Artery Disease and treated at least 10 patients with the conditions in 2006 to 2009. Treatment times were analyzed for 1,976 patients with acute ischemic stroke and 59,823 patients with STEMI. Results were published in Circulation: Cardiovascular Quality and Outcomes on March 10.

The study found no correlation between the hospitals' door-to-needle and door-to-balloon times or between the proportions of eligible patients treated within the target time windows for the two conditions. The lack of correlation persisted after risk adjustment and when the same comparisons were made using data from 2013 to 2014, leading the study authors to conclude that no correlation existed in either observed or risk-adjusted times to treatment.

The findings align with previous research finding that although a hospital's high performance on one measure of cardiovascular care may be associated with higher-quality care for other cardiovascular conditions, the effect does not extend to conditions outside the subspecialty, the study authors said. The lack of correlation might be due to differences in emergency evaluation and care processes and/or different degrees of investment in improvement efforts for the two conditions. The authors noted that overall the hospitals were significantly better at meeting door-to-balloon time goals than those for door-to-needle time and that performance ranged more widely among hospitals on the latter measure.

The results could potentially be improved by more interdisciplinary cooperation and coordinated approaches, for example, assessing whether ED processes used for STEMI could be adapted for stroke response, the authors suggested. “Rather than singularly focusing on process improvement for individual conditions, there may be value in efforts to improve timely care for multiple acute disease states with more coordinated efforts,” they wrote.