Impact of a statewide ST-segment-elevation myocardial infarction regionalization program on treatment times for women, minorities, and the elderly
Abstract
BACKGROUND: Prior studies have demonstrated differences in time to reperfusion for ST-segment-elevation myocardial infarction (STEMI) in women, minorities, and the elderly, relative to their counterparts. Regionalization has been shown to improve overall STEMI treatment times, but its impact on care differences among these important patient subgroups is unknown. The objective of this analysis was to assess the impact of a statewide system of STEMI care (The Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments) on treatment times according to patient sex, race, and age. METHODS AND RESULTS: STEMI treatment times were determined before (July 2005 to September 2005) and after (January 2007 to March 2007) a year-long implementation of coordinated regional treatment protocols. Times in the pre- and postintervention periods were compared by mixed-effects models. A total of 2063 STEMI patients were analyzed: 1140 at percutaneous coronary intervention hospitals and 923 at non-percutaneous coronary intervention hospitals. The Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments was associated with significant improvements in treatment times in women and the elderly, including door-to-ECG, door-to-device, door-in-door-out, and door-to-needle times (all P<0.05). Temporal improvements in treatment times at percutaneous coronary intervention hospitals were not significantly different in blacks than in whites. There was a reduction in baseline treatment disparities in door-to-ECG times in women versus men (4.4-minute reduction in difference; 95% CI, -8.1 to -0.4; P=0.03). After Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments, an age-treatment time gap persisted in the elderly, relative to younger patients. CONCLUSIONS: A statewide STEMI regionalization program was associated with comparable improvement in treatment times for female, black, and elderly patients compared with middle-aged, white male patients. Nevertheless, there remain opportunities to further narrow treatment differences, particularly among the elderly.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 34 · Cited by 80
- Authors
- Glickman, S. W., Granger, C. B., Ou, F.-S., O'Brien, S., Lytle, B. L., Cairns, C. B., Mears, G., Hoekstra, J. W., Garvey, J. L., Peterson, E. D., & Jollis, J. G.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- From the Duke Clinical Research Institute, Durham, NC (S.W.G., C.B.G., F.S.O., S.O., B.L.L., E.D.P.); Department of Medicine, Duke University Medical Center, Durham, NC (S.W.G., C.B.G., E.D.P., J.G.J.); the Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill (S.W.G., C.B.C., G.M.); Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (J.W.H.); and the Department of Emergency Medicine, Carolinas Medical Center,...
- ORCID
- Venue
- Circulation Cardiovascular Quality and Outcomes
- Published
- 2010-09
- Volume
- 3
- Issue
- 5
- Pages
- 514-521
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- OpenAlex
- W2163292134
- Cited by
- 80
- References
- 34
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 14 · 2019: 2 · 2018: 7 · 2017: 2 · 2016: 5 · 2015: 4 · 2014: 3 · 2013: 8 · 2012: 10
- FWCI
- 6.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- ST-elevation myocardial infarction, regionalization of care, treatment duration, percutaneous coronary intervention, door-to-needle time, door-to-ECG time, racial disparities, sex disparities, elderly patients, emergency department, North Carolina
- MeSH terms
- Aged, Clinical Protocols, Electrocardiography, Female, Health Services Accessibility, Humans, Male, Middle Aged, Minority Groups, Myocardial Infarction, North Carolina, State Health Plans, Time Factors, Women
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
