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Time definitely is muscle

Primary percutaneous coronary intervention has a proven role for patients with ST segment elevation myocardial infarction. A prospective analysis of “door-to-balloon” times in over 43 000 patients in the US who had ST elevation myocardial infarction yielded interesting results. It emphasises the ideal of a delay of <90 minutes and further defines the relationship of delay to mortality beyond this. Inter-hospital transfers were excluded from the analysis. Median time to balloon intervention was 83 minutes, with 58% of patients being treated in <90 minutes. Overall, in-hospital mortality was 4.6%. Mortality fell as low as 3.2% when door-to-balloon time was <60 minutes but more than doubled when the time delay was >120 minutes (BMJ 2009;338:1807–14).

Hyper-users

Frequent attenders, frequent flyers and repeat offenders are now officially termed “hyper-users”! They certainly seem to have a significant effect upon the systems that they use. A retrospective US study examined the characteristics of patients who attended the emergency department more than once per month during a 3-year period. …

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