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Door-to-Electrocardiogram Time Disparities in Acute Coronary Syndrome: Predictors and Clinical Outcomes in a Contemporary Community Hospital Cohort.

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Τίτλος: Door-to-Electrocardiogram Time Disparities in Acute Coronary Syndrome: Predictors and Clinical Outcomes in a Contemporary Community Hospital Cohort.
Συγγραφείς: Abed M; From the BayCare Health System, St. Anthony's Hospital, St. Petersburg, FL., Sakr Y, Alshlah A, Patel D, Sharma R, Bernard R, Tariq Z, Chen J, Klimek P, Nguyen H, Angel C
Πηγή: Critical pathways in cardiology [Crit Pathw Cardiol] 2026 Sep 01; Vol. 25 (3), pp. e0429. Date of Electronic Publication: 2026 Jun 30.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Lippincott, Williams & Wilkins Country of Publication: United States NLM ID: 101165286 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1535-2811 (Electronic) Linking ISSN: 15352811 NLM ISO Abbreviation: Crit Pathw Cardiol Subsets: MEDLINE
Imprint Name(s): Original Publication: Hagerstown, MD : Lippincott, Williams & Wilkins c2002-
Ιατρικοί όροι (MeSH): Acute Coronary Syndrome*/diagnosis , Acute Coronary Syndrome*/mortality , Emergency Service, Hospital*/statistics & numerical data , Time-to-Treatment*/statistics & numerical data , Electrocardiography* , Hospitals, Community*, Hospital Mortality/trends ; Length of Stay/statistics & numerical data ; Humans ; Female ; Retrospective Studies ; Middle Aged ; Male ; Aged ; Treatment Delay ; Time Factors ; Triage
Περίληψη: Background: Door-to-electrocardiogram (D2E) time is a critical quality metric in evaluating patients with suspected acute coronary syndromes (ACS), yet adherence to the ≤10-minute benchmark remains suboptimal. This study aimed to quantify D2E performance, identify predictors of delayed electrocardiogram (EKG) acquisition, and evaluate associations between D2E delays, in-hospital mortality, and length of stay (LOS).
Objective: To quantify D2E performance, identify patient- and system-level predictors of delayed EKG acquisition, and evaluate associations between D2E delays, in-hospital mortality, and LOS.
Methods: This retrospective cohort study included adults presenting to a single community hospital emergency department in 2024 with symptoms suggestive of ACS. The primary outcome was receipt of a 12-lead EKG within 10 minutes of arrival. Secondary outcomes included D2E distribution, in-hospital mortality, and hospital LOS. Multivariable logistic regression examined predictors of D2E >10 minutes.
Results: Among 3435 patients (median age 62 years; 52.3% female), 49.7% achieved D2E ≤10 minutes (median 10.0 minutes). In ACS subgroup analysis, female sex, atypical presentation, lower triage acuity, and afternoon shift were independently associated with D2E >10 minutes. Delayed EKG acquisition correlated with longer LOS, including a higher proportion of stays >4 days and a higher median LOS (3.0 vs. 2.0 days, P < 0.01). Overall, in-hospital mortality was 6.5%.
Conclusions: Fewer than 5 in 10 patients met the 10-minute D2E target. Delays were more frequent among women, patients with atypical presentations, lower triage acuity, and those arriving during afternoon shifts. Delayed EKG acquisition was associated with prolonged hospitalization, underscoring D2E time as a modifiable process measure.
(Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.)
References: Rao SV, O’Donoghue ML, Ruel M, et al.; Peer Review Committee Members. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2025;85:2135–2237.
Lin YT, Chen HA, Wu HY, et al. Influence of the door-to-ECG time on the prognosis of patients with acute coronary syndrome. Acta Cardiol Sin. 2023;39:127–134.
Mackay MH, Ratner PA, Veenstra G, et al. Racism is not a factor in door-to-electrocardiogram times of patients with symptoms of acute coronary syndrome: a prospective, observational study. Acad Emerg Med. 2019;26:491–500.
Diercks DB, Peacock WF, Hiestand BC, et al. 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). Am J Cardiol. 2006;97:437–442.
Diercks DB, Kirk JD, Lindsell CJ, et al. Door-to-ECG time in patients with chest pain presenting to the ED. Am J Emerg Med. 2006;24:1–7.
Yiadom MYAB, Gong W, Patterson BW, et al. Fallacy of median door-to-ECG time: hidden opportunities for STEMI screening improvement. J Am Heart Assoc. 2022;11:e024067.
Yiadom MYAB, Gong W, Bloos SM, et al. Shorter door-to-ECG time is associated with improved mortality in STEMI patients. J Clin Med. 2024;13:2650.
Pearlman MK, Tanabe P, Mycyk MB, et al. Evaluating disparities in door-to-EKG time for patients with noncardiac chest pain. J Emerg Nurs. 2008;34:414–418.
Srivatsa S, Ozen Z, English T, et al. Reducing door-to-ECG time in the emergency department: a quality improvement report. BMJ Open Qual. 2025;14:e003492.
Lee CK, Meng SW, Lee MH, et al. The impact of door-to-electrocardiogram time on door-to-balloon time after achieving the guideline-recommended target rate. PLoS One. 2019;14:e0222019.
Mousavi RA, Lamm G, Will M, et al. Sex differences in the management and outcome of acute coronary syndrome-Still an issue of equal treatment? Wien Klin Wochenschr. 2023;135:663–666.
van Oosterhout REM, de Boer AR, Maas AHEM, et al. Sex differences in symptom presentation in acute coronary syndromes: a systematic review and meta-analysis. J Am Heart Assoc. 2020;9:e014733.
Araújo C, Laszczyńska O, Viana M, et al. Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study. BMJ Open. 2018;8:e018798.
Kwok CS, Bennett S, Holroyd E, et al. Characteristics and outcomes of patients with acute coronary syndrome who present with atypical symptoms: a systematic review, pooled analysis and meta-analysis. Coron Artery Dis. 2025;36:240–251.
Pouyamehr A, Mirhaghi A, Sharifi MD, et al. Comparison between emergency severity index and heart failure triage scale in heart failure patients: a randomized clinical trial. World J Emerg Med. 2019;10:215–221.
Su HY, Tsai JL, Hsu YC, et al. A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction. Sci Rep. 2021;11:6358.
Turner D, Yu J, Murphy D, et al. Triage to electrocardiogram sign-off time in patients with acute coronary syndrome at a metropolitan Sydney hospital. Emerg Med Australas. 2023;35:624–629.
Stocker MD, Schaeffer C, Cox R, et al. Improving door-to-ECG time at a quaternary care emergency department. Jt Comm J Qual Patient Saf. 2025;51:701–710.
Contributed Indexing: Keywords: acute coronary syndrome; door-to-EKG time; emergency service; healthcare disparities; hospital; quality improvement; time-to-treatment
Entry Date(s): Date Created: 20260520 Date Completed: 20260821 Latest Revision: 20260821
Update Code: 20260821
PubMed Central ID: PMC13485466
DOI: 10.1097/HPC.0000000000000429
PMID: 42159013
Βάση Δεδομένων: MEDLINE
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  Data: Door-to-Electrocardiogram Time Disparities in Acute Coronary Syndrome: Predictors and Clinical Outcomes in a Contemporary Community Hospital Cohort.
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  Data: Background: Door-to-electrocardiogram (D2E) time is a critical quality metric in evaluating patients with suspected acute coronary syndromes (ACS), yet adherence to the ≤10-minute benchmark remains suboptimal. This study aimed to quantify D2E performance, identify predictors of delayed electrocardiogram (EKG) acquisition, and evaluate associations between D2E delays, in-hospital mortality, and length of stay (LOS).&lt;br /&gt;Objective: To quantify D2E performance, identify patient- and system-level predictors of delayed EKG acquisition, and evaluate associations between D2E delays, in-hospital mortality, and LOS.&lt;br /&gt;Methods: This retrospective cohort study included adults presenting to a single community hospital emergency department in 2024 with symptoms suggestive of ACS. The primary outcome was receipt of a 12-lead EKG within 10 minutes of arrival. Secondary outcomes included D2E distribution, in-hospital mortality, and hospital LOS. Multivariable logistic regression examined predictors of D2E &amp;gt;10 minutes.&lt;br /&gt;Results: Among 3435 patients (median age 62 years; 52.3% female), 49.7% achieved D2E ≤10 minutes (median 10.0 minutes). In ACS subgroup analysis, female sex, atypical presentation, lower triage acuity, and afternoon shift were independently associated with D2E &amp;gt;10 minutes. Delayed EKG acquisition correlated with longer LOS, including a higher proportion of stays &amp;gt;4 days and a higher median LOS (3.0 vs. 2.0 days, P &amp;lt; 0.01). Overall, in-hospital mortality was 6.5%.&lt;br /&gt;Conclusions: Fewer than 5 in 10 patients met the 10-minute D2E target. Delays were more frequent among women, patients with atypical presentations, lower triage acuity, and those arriving during afternoon shifts. Delayed EKG acquisition was associated with prolonged hospitalization, underscoring D2E time as a modifiable process measure.&lt;br /&gt; (Copyright &#169; 2026 Wolters Kluwer Health, LLC. All rights reserved.)
– Name: Ref
  Label: References
  Group: RefInfo
  Data: Rao SV, O’Donoghue ML, Ruel M, et al.; Peer Review Committee Members. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2025;85:2135–2237.&lt;br /&gt;Lin YT, Chen HA, Wu HY, et al. Influence of the door-to-ECG time on the prognosis of patients with acute coronary syndrome. Acta Cardiol Sin. 2023;39:127–134.&lt;br /&gt;Mackay MH, Ratner PA, Veenstra G, et al. Racism is not a factor in door-to-electrocardiogram times of patients with symptoms of acute coronary syndrome: a prospective, observational study. Acad Emerg Med. 2019;26:491–500.&lt;br /&gt;Diercks DB, Peacock WF, Hiestand BC, et al. Frequency and consequences of recording an electrocardiogram &amp;gt;10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE Initiative). Am J Cardiol. 2006;97:437–442.&lt;br /&gt;Diercks DB, Kirk JD, Lindsell CJ, et al. Door-to-ECG time in patients with chest pain presenting to the ED. Am J Emerg Med. 2006;24:1–7.&lt;br /&gt;Yiadom MYAB, Gong W, Patterson BW, et al. Fallacy of median door-to-ECG time: hidden opportunities for STEMI screening improvement. J Am Heart Assoc. 2022;11:e024067.&lt;br /&gt;Yiadom MYAB, Gong W, Bloos SM, et al. Shorter door-to-ECG time is associated with improved mortality in STEMI patients. J Clin Med. 2024;13:2650.&lt;br /&gt;Pearlman MK, Tanabe P, Mycyk MB, et al. Evaluating disparities in door-to-EKG time for patients with noncardiac chest pain. J Emerg Nurs. 2008;34:414–418.&lt;br /&gt;Srivatsa S, Ozen Z, English T, et al. Reducing door-to-ECG time in the emergency department: a quality improvement report. BMJ Open Qual. 2025;14:e003492.&lt;br /&gt;Lee CK, Meng SW, Lee MH, et al. The impact of door-to-electrocardiogram time on door-to-balloon time after achieving the guideline-recommended target rate. PLoS One. 2019;14:e0222019.&lt;br /&gt;Mousavi RA, Lamm G, Will M, et al. Sex differences in the management and outcome of acute coronary syndrome-Still an issue of equal treatment? Wien Klin Wochenschr. 2023;135:663–666.&lt;br /&gt;van Oosterhout REM, de Boer AR, Maas AHEM, et al. Sex differences in symptom presentation in acute coronary syndromes: a systematic review and meta-analysis. J Am Heart Assoc. 2020;9:e014733.&lt;br /&gt;Ara&#250;jo C, Laszczyńska O, Viana M, et al. Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study. BMJ Open. 2018;8:e018798.&lt;br /&gt;Kwok CS, Bennett S, Holroyd E, et al. Characteristics and outcomes of patients with acute coronary syndrome who present with atypical symptoms: a systematic review, pooled analysis and meta-analysis. Coron Artery Dis. 2025;36:240–251.&lt;br /&gt;Pouyamehr A, Mirhaghi A, Sharifi MD, et al. Comparison between emergency severity index and heart failure triage scale in heart failure patients: a randomized clinical trial. World J Emerg Med. 2019;10:215–221.&lt;br /&gt;Su HY, Tsai JL, Hsu YC, et al. A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction. Sci Rep. 2021;11:6358.&lt;br /&gt;Turner D, Yu J, Murphy D, et al. Triage to electrocardiogram sign-off time in patients with acute coronary syndrome at a metropolitan Sydney hospital. Emerg Med Australas. 2023;35:624–629.&lt;br /&gt;Stocker MD, Schaeffer C, Cox R, et al. Improving door-to-ECG time at a quaternary care emergency department. Jt Comm J Qual Patient Saf. 2025;51:701–710.
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      – TitleFull: Door-to-Electrocardiogram Time Disparities in Acute Coronary Syndrome: Predictors and Clinical Outcomes in a Contemporary Community Hospital Cohort.
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              Value: 1535-2811
          Numbering:
            – Type: volume
              Value: 25
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Critical pathways in cardiology
              Type: main
ResultId 1