Obstacles to Care Due to COVID-19 Pandemic Should Be Addressed to Improve Time-to-Care of Heart Attack Patients

Typically, a door-to-balloon (D2B) time of 90 minutes or less is associated with improved outcomes for those experiencing a heart attack; however, obstacles to care, such as COVID-19 screenings, have been associated with increased D2B times, according to the results of a study presented at the American College of Cardiology Quality Summit 2023. The findings also indicated that many health care facilities are still recovering from the COVID-19 pandemic, which has caused D2B times to continue to lag, according to the authors.

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“Some of the new national standards created in response to the COVID-19 pandemic created obstacles to heart attack care by adding minutes to D2B time. Although the incidence of COVID myocarditis increased during the pandemic and led to false activations, the total number of STEMI activations actually decreased,” Sara Belajonas, MSN, MBA, CCRN, APN-C, the chest pain coordinator at Ocean University Medical Center (OUMC) in Brick Township, New Jersey, said in a statement. “I believe this created a scenario that our [ST elevation myocardial infarction (STEMI)] process was not utilized as often, therefore creating the need for re-education and the refocusing on the importance of time.”

According to the statement, health care professionals try to get patients who had a heart attack to the emergency department’s (ED) catheterization laboratory to reopen a blockage in the heart within 90 minutes or less, which is referred to as D2B. Other research has indicated that further decreasing D2B time can improve outcomes and decrease mortality.

In the review, investigators examined the door-to-electrocardiogram, arrival to STEMI, arrival to case start, and D2B. They aimed to determine whether patients were spending too much time in the ED for reasons that could have affected patients’ processing time, which could indicate a need overhaul the time and processes for more effective patient care.

According to data from the OUMC NCDR CathPCI, in April 2022, there was a climbing of D2B time in the first quarter at 73 minutes, below their goal of 60 minutes. Prior to the pandemic, the medical center averaged approximately 60 minutes for approximately 2 years, according to the statement. Globally, heart attack hospitalizations decreased by 28% during the COVID-19 pandemic, which investigators found was not due to lower incidence, but because patients did not seek medical treatment.

At the end of 2022, the D2B time reduced from 73 minutes to 72 minutes; however, in August 2023, the medical center made their goal of 60 minutes, according to the statement.

Processes that were implemented to reduce these times included: re-education of multidisciplinary teams; involvement of additional staff assistance; review of all STEMI cases with time interval drill down; re-educate on the American College of Cardiology recommendation to pre-activate STEMIs; re-educate STEMI prep; annual STEMI drills; and collaboration of emergency medical services (EMS) to drill down transport delays.

Investigators also found that not all STEMIs that were brought in by life support units were pre-activated. Pre-activation takes place when the cardiac catheterization laboratory is notified in advance of the patient’s arrival. Typically, the pre-activation can help patients bypass typical protocol of going to the ED before the cardiac catheterization laboratory, which saves time, according to the authors.

“We can learn a lot from these trends to help prepare ourselves for the future. Community education is imperative,” Belajonas said in the statement. “Utilizing past research and trends, we already know symptomatic patients are not getting the emergency care they need. All health care workers should do their part in educating the public on the importance of early heart attack care.”

Furthermore, the authors stated that the ongoing shortages of health care and EMS workers affects STEMI care. They added that ongoing staff education will be key to update processes and time management, while providing feedback and drills to identify gaps in care.

Belajonas added that there has been an increase in STEMI over the past few months and expects to see the trends repeat as the COVID-19 numbers rise and fall.

Reference

Challenges in acute heart attack care continue post COVID-19. News release. EurekAlert. October 4, 2023. Accessed October 5, 2023. https://www.eurekalert.org/news-releases/1003542