Abstract 4358574: Assessment of Guideline-Recommended Treatment Times for ST-Elevation Myocardial Infarction Across Critical Access Hospital Networks

Abstract

Background: ST elevation myocardial infarction (STEMI), characterized by complete coronary blockage, remains acutely lethal despite medical advances, with mortality rates unchanged over the past decade. Guidelines recommend electrocardiogram (ECG) within 10 minutes, fibrinolytics within 30 minutes when timely primary percutaneous coronary intervention (pPCI, 90-minute target) isn't feasible. Rural critical access hospitals face resource constraints potentially affecting adherence to these time-sensitive interventions. Hypothesis: CA hospitals demonstrate significantly lower adherence to STEMI guideline benchmarks compared to nCA hospitals, potentially contributing to persistent mortality rates despite medical advances. Aim: To evaluate disparities in guideline recommended times for STEMI care in CA and nCA hospitals. Methods: This retrospective cohort study analyzed 363,172 adult STEMI patients across the US from the American Heart Association Get With The Guidelines database. Multivariable logistic regression models assessed associations between hospital designation and guideline adherence (<10 min for ECG, <30 min for fibrinolysis, and <90 min for pPCI), calculating odds ratios (OR) with 95% confidence intervals (95%CI). Regression models were adjusted for age and biological sex (p <0.05 significance). Results: Analysis revealed no statistically significant difference in meeting ECG timing guidelines between CA and nCA hospitals. However, adjusted logistic regressions demonstrated that CA hospitals were 51% more likely to not meet fibrinolysis guideline recommendations compared to nCA hospitals (aOR:1.51, 95%CI: 1.10-2.05, p=0.009, Figure 1). Similarly, nCA hospitals were 7% more likely to not meet pPCI guideline recommendations (aOR: 1.07, 95%CI: 1.02-1.13, p=0.005) compared to nCA hospitals. Conclusions: CA hospitals meet diagnostic ECG timing guidelines but significantly underperform in treatment implementation compared to nCA facilities, with delays in both pPCI (standard care) and fibrinolysis (alternative strategy). These treatment disparities highlight specific targets for quality improvement initiatives in rural settings that could help reduce persistent STEMI mortality in underserved regions.