Regional systems of care can improve key processes in treating heart attack patients

January 24, 2017 – The American Heart Association’s Mission: Lifeline STEMI Systems Accelerator project is the first effort to regionalize STEMI care across the United States.

Efforts to regionalize and optimize care for ST-segment–elevation myocardial infarction (STEMI) patient care can result in shorter reperfusion times, which improve patient care.

Primary percutaneous coronary intervention (PCI) is the preferred method of revascularization for STEMI patients. For these patients, timely reperfusion is essential to ensuring the best possible outcomes. Current guidelines recommend that patients undergo PCI no more than 90 minutes after the first point of care.

Christopher Fordyce, MD

However, between 30 and 50 percent of patients do not receive care within that timeframe. The American Heart Association’s Mission: Lifeline STEMI Systems Accelerator project, the first effort to regionalize STEMI care nationally, was developed to improve reperfusion times by coordinating efforts by emergency medical service (EMS) providers and hospitals.

In a study published this month in Circulation: Cardiovascular Interventions with an editorial comment by Harvey White of Auckland City Hospital, a team of researchers led by former DCRI Fellow Christopher Fordyce, MD, MHS, MSc, examined whether implementing these improvements was associated with system performance improvement.

The STEMI Systems Accelerator program was developed and implemented in 16 US metropolitan areas between March 2012 and July 2014. It included 171 hospitals and 23,809 patients. For this study, Fordyce and his colleagues contacted STEMI Systems Accelerator coordinators at each participating hospital before and after the program was implemented to answer a series of questions about four key process in reperfusion care for STEMI patients:

  • Prehospital cardiac catheterization laboratory activation for patients presenting directly via EMS to a PCI-capable hospital
  • Single-call primary PCI transfer protocol for patients presenting to a non-PCI-capable hospital
  • Emergency department bypass for patients presenting directly via EMS to a PCI-capable hospital
  • Emergency department bypass for patients transferred from a non-PCI-capable hospital to a PCI-capable hospital

This information was then compared to patient data compiled over the same period. The researchers found that uptake of each process increased after implementing the STEMI Systems Accelerator program: pre-hospital catheterization laboratory activation increased from 62 percent to 91 percent, single-call transfer protocol from an outside facility from 45 percent to 70 percent, emergency department bypass for EMS direct presenters from 48 percent to 59 percent, and emergency department transfers increased from 56 to 79 percent.

The researchers also noted significant differences in median first medical contact-to-device times among groups implementing pre-hospital activation (88 minutes implementers versus 89 minutes preexisting versus 98 minutes non-implementers). Patients treated at hospitals implementing single call transfer protocols had shorter median first medical contact-to-device times (112 versus 128 versus 152 minutes). Emergency department bypass was also associated with shorter median first medical contact-to-device times for emergency medical services direct presenters (84 versus 88 versus 94 minutes) and transfers (123 versus 127 versus 167 minutes).

These findings, Fordyce and his colleagues concluded, illustrate that programs such as STEMI Systems Accelerator can produce a quick and meaningful impact in key processes. Efforts to optimize STEMI systems should continue to focus of these processes, they added.

In addition to Fordyce, the study’s authors included Hussein R. Al-Khalidi, PhD; James G. Jollis, MD; Mayme L. Roettig, RN, MSN; Joan Gu, MS; Akshay Bagai, MD, MHS; Peter B. Berger, MD; Claire C. Corbett, MMS; Harold L. Dauerman, MD; Kathleen Fox, RN, BS; J. Lee Garvey, MD†; Timothy D. Henry, MD; Ivan C. Rokos, MD; Matthew W. Sherwood, MD, MHS; B. Hadley Wilson, MD; and Christopher B. Granger, MD.