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Of all patients with ST segment elevation myocardial infarction (STEMI), approximately two-thirds present to a hospital not capable of percutaneous coronary intervention. Transfer from these hospitals to a STEMI receiving center (SRC) has been shown to significantly delay time to reperfusion in patients with STEMI, but the factors that affect this delay have not been well-studied. The aim of this consensus study was to derive a list of system practices to minimize the transfer time to an SRC.
We performed a three-round modified Delphi study. A comprehensive literature review was used to identify candidate system practices. Emergency medical services, emergency medicine, and cardiology “experts” who authored relevant published studies and/or served as panelists on relevant regional committees were invited to participate. Consensus was defined as 80% agreement that a variable was “very important (5)” or “important (4)” with a mean ≥4.25 OR 80% agreement that a variable was “not important (1)” or “somewhat important (2)” with a mean ≤1.75. In Round 1, participants rated the candidate items using the scale above (including “important (3)”) and were invited to suggest additional items. Individual feedback was provided, and participants discussed non-consensus and additional items via conference calls. In Round 2, participants rated the items using the same scale. In Round 3, participants ranked the consensus items from Rounds 1–2 from most to least important, and the summary score for each item was calculated. Descriptive statistics are presented.
Ninety-eight experts were invited to contribute; 29 participated in Round 1, 22 in Round 2, and 14 in Round 3. Fifty-one total items were evaluated in Rounds 1–2. Consensus was achieved on 12 items in Round 1 and six additional items in Round 2. The most important system practices in Round 3 were prehospital providers performing an electrocardiogram and referring hospitals and SRCs having an established transfer protocol.
Expert participants identified 18 system practices that are critical in minimizing transfer time to SRCs. These factors should be considered in the development of STEMI systems of care.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: STEMI Topics
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1171-215
- 2013 American College of Cardiology Foundation