By AMERICAN HEART ASSOCIATION NEWS
People having the most deadly type of heart attack received lifesaving treatment sooner when emergency medical services and hospital providers used a coordinated system, according to a new study.
The American Heart Association Mission: Lifeline STEMI Systems Accelerator demonstration project created regional care systems to increase the number of people treated within guidelines in July 2012-December 2013. It’s the largest effort to organize regional care for ST segment elevation myocardial infarction, or STEMI, which happens when blood supply to the heart is completely blocked. Quickly opening the blocked artery can restore normal blood flow, minimize heart damage and save lives.
National guidelines recommend the blockage be opened and blood flow restored within 90 minutes of patients’ first contact with emergency medical personnel for those taken straight to a hospital that performs percutaneous coronary interventions. The goal is within 120 minutes for patients transferred from hospitals that don’t perform PCI.
The demonstration involved 484 hospitals and 1,253 EMS agencies in 16 regions in the United States treating 23,809 STEMI patients. EMS transported 11,765 patients, 6,502 self-transported directly to PCI-capable hospitals and 5,542 patients transferred from another facility.
During the demonstration project, the increase in patients meeting the guideline goals was modest, but significant:
- 59 percent to 61 percent for patients presenting directly to PCI-capable hospitals
- 50 percent to 55 percent for those transported by EMS to PCI-capable hospitals
- 44 percent to 48 percent for those transferred from other facilities
“This project shows it is possible to coordinate emergency cardiovascular systems and transform care in some of the largest U.S. cities, including New York, Houston and Atlanta,” said Christopher B. Granger, M.D., study co-author and professor of medicine at Duke University in Durham, North Carolina. “This coordinated care between EMS and hospitals shortens emergency department times and correlates with lower mortality.”
Up to half of the more than 250,000 people who have a STEMI each year aren’t treated within the recommended time due to lack of coordination among those who care for them before and after they get to the hospital. Treatment plans are also diverse among the 15,000 EMS agencies and 5,200 acute care hospitals in the United States, said James G. Jollis, M.D., clinical professor of medicine at the University of North Carolina in Chapel Hill.
“Ideally, paramedics using a 12-lead EKG can recognize if an artery is blocked, diagnose STEMI in the field and route patients straight to specialized hospitals as they notify the hospital to activate the heart catheterization team immediately,” Jollis said.
The study is published in the American Heart Association journal Circulation.