Introduction Advances in ST-segment elevation myocardial infarction (STEMI) management have involved improving the clinical processes connecting patients with timely emergency cardiovascular care. Screening upon emergency department (ED) arrival for an early ECG to diagnose STEMI, however, is not optimal for all patients. In addition, the degree to which timely screening and diagnosis are associated with improved time to intervention and postpercutaneous coronary intervention outcomes, under more contemporary practice conditions, is not known.
Methods We present the methods for a retrospective multicentre cohort study anticipated to include 1220 patients across seven EDs to (1) evaluate the relationship between timely screening and diagnosis with treatment and postintervention clinical outcomes; (2) introduce novel measures for cross-facility performance comparisons of screening and diagnostic care team performance including: door-to-screening, door-to-diagnosis and door-to-catheterisation laboratory arrival times and (3) describe the use of electronic health record data in tandem with an existing disease registry.
Ethics and dissemination The completion of this study will provide critical feedback on the quality of screening and diagnostic performance within the contemporary STEMI care pathway that can be used to (1) improve emergency care delivery for patients with STEMI presenting to the ED, (2) present novel metrics for the comparison of screening and diagnostic care and (3) inform the development of screening and diagnostic support tools that could be translated to other care environments. We will disseminate our results via publication and quality performance data sharing with each site. Institutional ethics review approval was received prior to study initiation.
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Contributors MYABY designed and coordinated the logistics of the study and served as lead investigator via the data coordinating centre. BEM, CWB, BWP, AMM, GS and MT are site principal investigators and coordinate study implementation within their institutions. CAJ is the lead staff biostatistician. KFM is the data coordinating centre’s Data Integrity Officer. BEJ is the study programme manager. JLW and SCD were site data abstractors who contributed to study methods development. CUL, TJW, SPC, ABS and RSD provided content-specific expertise advising study design and implementation. TJV and GRB provided content-specific data analysis guidance. DL was the overseeing statistician who codesigned the study with MYABY and will oversee final data analysis with MYABY.
Funding Research reported in this publication was supported by the National Heart Lung and Blood Institute’s (NHLBI) award numbers 5K12HL109019, 1K23HL133477, 5K08HL130546.
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Competing interests MYABY is Director of the Emergency Department Operations Study Group (EDOSG). CWB is a member of the Advisory Board, consultant for Roche Diagnostics and Janssen Pharmaceuticals, and has received research funding from Boehringer Ingelheim. ABS has also received grant support from Abbott Diagnostics and Roche Diagnostics. He is a consultant for Roche Diagnostics, Novartis Pharmaceuticals Corp, Alere Diagnostics, Trevena, Beckman Coulter and Siemens. SPC received grant research support from NIH/NHLBI, PCORI, Cardiorentis, Novartis and Cardioxyl and consultant support/other from Novartis, Trevena, Cardiorentis, Cardioxyl and Siemens.
Patient consent Obtained.
Ethics approval Ethics approval was obtained from the Vanderbilt IRB, IRBChoice (a single IRB approval mechanism used by University of Pennsylvania and Oregon Health and Sciences University), and the institutional IRBs of Brigham and Women’s Hospital, University of California at Davis, and University of Wisconsin.
Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.
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