Improving patient outcomes from acute cardiovascular events through regionalized systems of care

ST-segment elevation myocardial infarction (STEMI), cardiac arrest, and ischemic stroke are a diverse group of cardiovascular illnesses linked by the necessity for timely intervention in order to maximize patient outcomes. Despite the known efficacies of therapies, such as emergent percutaneous coronary intervention (PCI), rapid administration of tissue plasminogen activator, and induction of therapeutic hypothermia after cardiac arrest, translating these discoveries into standard practice nationwide has proven difficult to achieve. Significant regional variations in practice are commonplace, and facilities with higher patient volumes of STEMI, cardiac arrest, and ischemic stroke consistently have better outcomes compared with lower-volume facilities. Such disparities in emergency care led the Institute of Medicine in 2006 to describe the existing emergency care system as "at the breaking point," and to call for "coordinated, regionalized, and accountable" systems of care. An effective and equitable regionalized emergency care system would resemble the existing US trauma system in some respects, with transparent and standard triage guidelines, cooperation between local and regional emergency medical service systems, and an integrated network of referring and receiving facilities. Emerging technologies, such as telemedicine, will likely play a significant role. Regionalized referral systems, such as designated PCI centers and designated stroke centers, are in existence, but have largely been reactive and local, and no mechanism is in place to ensure equitable distribution of such facilities across all geographic regions. As scientific advances in the treatment of these conditions continue to evolve, so too must the system of care that provides these therapies. Evidence suggests that regionalized systems of care for acute cardiovascular events may increase compliance with existing life-saving guidelines and improve patient outcomes.