Identifying predictors of delayed revascularisation for women with ST elevation myocardial infarction to improve access to evidence-based practice

A/Prof. Lisa Kuhn1, Dr Karen Page3, Dr Mohammadreza Mohebbi2, Associate Professor William van Gaal4, Professor Julie Considine2
1Monash University, Clayton, Australia, 2Deakin University, Burwood, Australia, 3Austin Health, Melbourne, Australia, 4Cardiology Department, Northern Health, Epping, Australia

Introduction. Timely access to evidence-based care reduces risk of death from ST-segment elevation myocardial infarction (STEMI). Research demonstrates women’s emergency department (ED) STEMI care is prone to unexplained delays. The aim of this study was to determine the factors associated with delayed ED STEMI care in women.
Methods. We retrospectively analysed patient-level data from three Australian EDs. Outcomes were triage score allocation, door-to-electrocardiograph (D2ECG) and door-to-balloon time (D2BT).
Results. A total of 471 women with STEMI included with a median age of 72 (IQR=60,83) years. Most patients were triaged according to evidence-based guidelines (83%). Acute pulmonary oedema caused the longest D2ECG delays (OR=3.441; 95%CI 1.24–9.55). Conversely, D2ECG delays were minimised by Code STEMI activation (OR=0.220; 95%CI 0.11–0.44), and high urgency triage score allocation (OR=0.042; 95%CI 0.01–0.20).
Prolonged D2BT occurred in patients with limitation of treatment documentation (OR=4.194; 95%CI 1.17–14.99). D2BT was reduced for patients born in English-speaking countries (OR=0.329; 95%CI 0.16–0.68), who had Code STEMI activated (OR=0.17; 95%CI 0.06–0.48) or short D2ECG times (OR=0.365; 95%CI 0.16–0.83).
Conclusions. Using patient-level data to examine predictors of delay in women’s ED STEMI care, this study provides a deeper understanding of patient, clinician and process factors influencing this time-critical ED care. It demonstrates the threshold for procuring ECGs in EDs should be low in women to expedite STEMI care. Further, although there are multiple causes of delays in D2BT for women, treatment decisions to undertake angioplasty made after STEMI is recognised are appropriate.

Associate Professor Lisa Kuhn is an emergency nurse with over 25 years of clinical, academic and research experience.  Lisa’s main research interest is to increase equity in early cardiovascular healthcare for women through generating and translating evidence into practice.  Lisa’s current research involves developing and testing a predictive model to reduce unwarranted variation from evidence-based practice for heart attacks in women.  Future research will involve translating the model into practice to improve patient outcomes. Lisa has received several peer-reviewed scientific awards, a postgraduate scholarship and a postdoctoral research fellowship.  She uses quantitative, qualitative and mixed methods to research a broad range of issues including heart disease and emergency care.