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Regional Systems of Care Demonstration Project: American Heart Association Mission: Lifeline STEMI Systems
James G Jollis1, Hussein R Al-Khalidi1, Mayme L Roettig1
1From University of North Carolina, Chapel Hill (J.G.J.); Duke Clinical Research Institute, Duke University, Durham, NC (H.R.A.-K., M.L.R., C.B.F., K.F., M.W.S., C.B.G.); Northwell Health, New Hyde Park, NY (P.B.B.); New Hanover Regional Medical Center, Wilmington, NC (C.C.C.); University of Vermont College of Medicine, Burlington (H.L.D.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); American Heart Association, Dallas, TX (T.G., R.E.S.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); UCLA-Olive View Medical Center, Los Angeles, CA (I.C.R.); and Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC (B.H.W.).
Insights
Coordinated regional reperfusion plans improved treatment times for ST-segment-elevation myocardial infarction (STEMI) patients, increasing the proportion meeting guideline goals. This initiative enhanced STEMI care across multiple regions.
Area of Science:
- Cardiology
- Public Health
- Healthcare Systems Management
Background:
- Many ST-segment-elevation myocardial infarction (STEMI) patients do not meet guideline goals for first medical contact-to-device time.
- Guideline goals are <90 minutes for direct PCI-capable hospital presentations and <120 minutes for transferred patients.
Purpose of the Study:
- To increase the proportion of STEMI patients treated within guideline-recommended first medical contact-to-device times.
- To evaluate the impact of coordinated regional reperfusion plans on STEMI treatment times.
Main Methods:
- Implementation of coordinated regional reperfusion plans involving leadership teams, standardized protocols, and feedback across 484 hospitals and 1253 EMS agencies in 16 US regions.
- Data collection and analysis of 23,809 STEMI patients between July 2012 and December 2013.
Main Results:
- A significant increase in patients meeting guideline goals for first medical contact-to-device time was observed.
- Proportion of directly presenting EMS-transported STEMI patients meeting goals increased from 50% to 55% (P<0.001).
- Proportion of transferred STEMI patients meeting goals increased from 44% to 48% (P=0.002).
Conclusions:
- The Mission: Lifeline STEMI Systems Accelerator project demonstrated the largest national effort to organize regional STEMI care.
- Coordinated regional STEMI care focusing on first medical contact-to-device time, protocols, and data reporting significantly improved treatment adherence to guidelines.
Background:
Up to 50% of patients fail to meet ST-segment-elevation myocardial infarction (STEMI) guideline goals recommending a first medical contact-to-device time of <90 minutes for patients directly presenting to percutaneous coronary intervention-capable hospitals and <120 minutes for transferred patients. We sought to increase the proportion of patients treated within guideline goals by organizing coordinated regional reperfusion plans.
Methods:
We established leadership teams, coordinated protocols, and provided regular feedback for 484 hospitals and 1253 emergency medical services (EMS) agencies in 16 regions across the United States.
Results:
Between July 2012 and December 2013, 23 809 patients presented with acute STEMI (direct to percutaneous coronary intervention hospital: 11 765 EMS transported and 6502 self-transported; 5542 transferred). EMS-transported patients differed from self-transported patients in symptom onset to first medical contact time (median, 47 versus 114 minutes), incidence of cardiac arrest (10% versus 3%), shock on admission (11% versus 3%), and in-hospital mortality (8% versus 3%; P<0.001 for all comparisons). There was a significant increase in the proportion of patients meeting guideline goals of first medical contact-to-device time, including those directly presenting via EMS (50% to 55%; P<0.001) and transferred patients (44%-48%; P=0.002). Despite regional variability, the greatest gains occurred among patients in the 5 most improved regions, increasing from 45% to 57% (direct EMS; P<0.001) and 38% to 50% (transfers; P<0.001).
Conclusions:
This Mission: Lifeline STEMI Systems Accelerator demonstration project represents the largest national effort to organize regional STEMI care. By focusing on first medical contact-to-device time, coordinated treatment protocols, and regional data collection and reporting, we were able to increase significantly the proportion of patients treated within guideline goals.
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