Reference: Terkelsen CJ, Jensen LO, Tilsted H-H, et al. Health care system delay and heart failure in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: Follow-up of population-based medical registry data. Ann Intern Med 2011; 155: 361-7.

In patients with ST-segment myocardial infarction (STEMI), delays in obtaining primary percutaneous coronary intervention (PCI) are associated with an increased need for subsequent care, both inpatient and outpatient, related to chronic heart failure (CHF). According to a paper published in the September 20, 2011, issue of Annals of Internal Medicine, the findings add to a large body of evidence that system delays, which are modifiable, can make a tremendous difference in patient outcome.

On multivariable analysis, treatment delay as a whole independently predicted readmissions or outpatient visits for CHF treatment (adjusted HR 1.04 per hour increase; 95% CI 1.008-1.06; P = 0.012). However, separating treatment delay into its 2 components—patient delay and system delay—showed that only system delay was associated with CHF-related readmission or outpatient contact. According to the study authors, the findings make sense because delayed reperfusion is associated with more extensive myocardial necrosis and reduced LVEF. They say that health care system delay is the ideal performance measure in triaging patients with STEMI for primary PCI.

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