Frequency and consequences of recording an electrocardiogram >10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE initiative)

Deborah B. Diercks, W. Frank Peacock, Brian C. Hiestand, Anita Y. Chen, Charles V. Pollack, J. Douglas Kirk, Sidney C. Smith, W. Brian Gibler, E. Magnus Ohman, Andra L. Blomkalns, L. Kristin Newby, Judith S. Hochman, Eric D. Peterson, Matthew T. Roe

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Abstract

We sought to determine the frequency of electrocardiographic (ECG) acquisition within 10 minutes of hospital arrival, factors associated with delayed ECG acquisition, and any relation among delayed ECG acquisition, treatment patterns, and clinical outcomes. We therefore analyzed data from 63,478 patients (26,615 women, 42%) with high-risk non-ST-segment elevation acute coronary syndromes (designated by positive cardiac markers and/or ischemic ST-segment changes) who were enrolled in the CRUSADE Quality Improvement Initiative from February 2001 to March 2004. Patients were categorized based on time to electrocardiography as delayed (>10 minutes from hospital arrival) or nondelayed (<10 minutes). Multivariable predictors of delayed ECG acquisition were determined. Overall, median time to electrocardiography was 15 minutes (25th to 75th percentile 7 to 32). ECG acquisition was delayed (median 25 minutes, 25th to 75th percentile 16 to 50) in 41,397 patients (65.2%). In the remaining 34.8%, time to electrocardiography was <10 minutes (median 5 minutes, 25th to 75th percentile 3 to 8). Women were more likely than men to have delayed ECG acquisition (69% vs 62%), and female gender was the most significant predictor of delayed ECG acquisition (odds ratio 1.29, 95% confidence interval 1.25 to 1.34). In conclusion, only 33% of high-risk patients with non-ST-segment elevation acute coronary syndrome had an initial electrocardiogram obtained <10 minutes of arrival as recommended. Women were significantly more likely than men to have delayed ECG acquisition. Emergency departments should focus on decreasing the time to initial ECG acquisition to improve treatment of acute coronary syndrome in this group.

Original languageEnglish (US)
Pages (from-to)437-442
Number of pages6
JournalAmerican Journal of Cardiology
Volume97
Issue number4
DOIs
StatePublished - Feb 15 2006

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Acute Coronary Syndrome
Hospital Emergency Service
Electrocardiography
Quality Improvement
Odds Ratio
Confidence Intervals
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Frequency and consequences of recording an electrocardiogram >10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE initiative). / Diercks, Deborah B.; Peacock, W. Frank; Hiestand, Brian C.; Chen, Anita Y.; Pollack, Charles V.; Kirk, J. Douglas; Smith, Sidney C.; Gibler, W. Brian; Ohman, E. Magnus; Blomkalns, Andra L.; Newby, L. Kristin; Hochman, Judith S.; Peterson, Eric D.; Roe, Matthew T.

In: American Journal of Cardiology, Vol. 97, No. 4, 15.02.2006, p. 437-442.

Research output: Contribution to journalArticle

Diercks, DB, Peacock, WF, Hiestand, BC, Chen, AY, Pollack, CV, Kirk, JD, Smith, SC, Gibler, WB, Ohman, EM, Blomkalns, AL, Newby, LK, Hochman, JS, Peterson, ED & Roe, MT 2006, 'Frequency and consequences of recording an electrocardiogram >10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE initiative)', American Journal of Cardiology, vol. 97, no. 4, pp. 437-442. https://doi.org/10.1016/j.amjcard.2005.09.073
Diercks, Deborah B. ; Peacock, W. Frank ; Hiestand, Brian C. ; Chen, Anita Y. ; Pollack, Charles V. ; Kirk, J. Douglas ; Smith, Sidney C. ; Gibler, W. Brian ; Ohman, E. Magnus ; Blomkalns, Andra L. ; Newby, L. Kristin ; Hochman, Judith S. ; Peterson, Eric D. ; Roe, Matthew T. / Frequency and consequences of recording an electrocardiogram >10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE initiative). In: American Journal of Cardiology. 2006 ; Vol. 97, No. 4. pp. 437-442.
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abstract = "We sought to determine the frequency of electrocardiographic (ECG) acquisition within 10 minutes of hospital arrival, factors associated with delayed ECG acquisition, and any relation among delayed ECG acquisition, treatment patterns, and clinical outcomes. We therefore analyzed data from 63,478 patients (26,615 women, 42{\%}) with high-risk non-ST-segment elevation acute coronary syndromes (designated by positive cardiac markers and/or ischemic ST-segment changes) who were enrolled in the CRUSADE Quality Improvement Initiative from February 2001 to March 2004. Patients were categorized based on time to electrocardiography as delayed (>10 minutes from hospital arrival) or nondelayed (<10 minutes). Multivariable predictors of delayed ECG acquisition were determined. Overall, median time to electrocardiography was 15 minutes (25th to 75th percentile 7 to 32). ECG acquisition was delayed (median 25 minutes, 25th to 75th percentile 16 to 50) in 41,397 patients (65.2{\%}). In the remaining 34.8{\%}, time to electrocardiography was <10 minutes (median 5 minutes, 25th to 75th percentile 3 to 8). Women were more likely than men to have delayed ECG acquisition (69{\%} vs 62{\%}), and female gender was the most significant predictor of delayed ECG acquisition (odds ratio 1.29, 95{\%} confidence interval 1.25 to 1.34). In conclusion, only 33{\%} of high-risk patients with non-ST-segment elevation acute coronary syndrome had an initial electrocardiogram obtained <10 minutes of arrival as recommended. Women were significantly more likely than men to have delayed ECG acquisition. Emergency departments should focus on decreasing the time to initial ECG acquisition to improve treatment of acute coronary syndrome in this group.",
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AU - Peacock, W. Frank

AU - Hiestand, Brian C.

AU - Chen, Anita Y.

AU - Pollack, Charles V.

AU - Kirk, J. Douglas

AU - Smith, Sidney C.

AU - Gibler, W. Brian

AU - Ohman, E. Magnus

AU - Blomkalns, Andra L.

AU - Newby, L. Kristin

AU - Hochman, Judith S.

AU - Peterson, Eric D.

AU - Roe, Matthew T.

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N2 - We sought to determine the frequency of electrocardiographic (ECG) acquisition within 10 minutes of hospital arrival, factors associated with delayed ECG acquisition, and any relation among delayed ECG acquisition, treatment patterns, and clinical outcomes. We therefore analyzed data from 63,478 patients (26,615 women, 42%) with high-risk non-ST-segment elevation acute coronary syndromes (designated by positive cardiac markers and/or ischemic ST-segment changes) who were enrolled in the CRUSADE Quality Improvement Initiative from February 2001 to March 2004. Patients were categorized based on time to electrocardiography as delayed (>10 minutes from hospital arrival) or nondelayed (<10 minutes). Multivariable predictors of delayed ECG acquisition were determined. Overall, median time to electrocardiography was 15 minutes (25th to 75th percentile 7 to 32). ECG acquisition was delayed (median 25 minutes, 25th to 75th percentile 16 to 50) in 41,397 patients (65.2%). In the remaining 34.8%, time to electrocardiography was <10 minutes (median 5 minutes, 25th to 75th percentile 3 to 8). Women were more likely than men to have delayed ECG acquisition (69% vs 62%), and female gender was the most significant predictor of delayed ECG acquisition (odds ratio 1.29, 95% confidence interval 1.25 to 1.34). In conclusion, only 33% of high-risk patients with non-ST-segment elevation acute coronary syndrome had an initial electrocardiogram obtained <10 minutes of arrival as recommended. Women were significantly more likely than men to have delayed ECG acquisition. Emergency departments should focus on decreasing the time to initial ECG acquisition to improve treatment of acute coronary syndrome in this group.

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