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Survey: Health systems improving in STEMI treatment

Wednesday May 23, 2012
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The number of systems of care that quickly transfer and treat patients with ST-segment elevation myocardial infarction has increased substantially across the nation, according to published research.

Results of a national survey from the American Heart Associationís Mission: Lifeline STEMI program found similar characteristics and challenges among regional care systems that treat patients with STEMI, the most severe form of MI.

Each year in the United States, nearly 300,000 people have a STEMI. Preventing death generally requires restoring blood flow, either by surgically opening the blocked vessel or by providing thrombolytics.

Ideally, the initial 9-1-1 call activates the STEMI system when someone suffers an MI. The continuum includes the care patients receive en route to and at hospitals.

Between April 2008 and January 2010, 381 STEMI-care systems, representing 899 hospitals in 47 states, responded to the Mission: Lifeline survey. Systems included at least one hospital that performs percutaneous coronary interventions and one emergency medical service group.

Two-thirds (67%) of the systems were in urban areas, and most followed standard quality procedures and policies, including admitting STEMI patients even when a hospital bed was not readily available (97%); requiring a single phone call to activate the catheterization lab for PCI treatment (92%); permitting the ED physician to activate the cath lab without consulting a cardiologist (87%) and allowing the cath lab to be activated without cardiology consult before the patient arrived at the hospital (78%); and participating in a data collection registry (84%).

The most common barrier to implementing systems was competition among hospitals (37%) and cardiology groups (21%). In addition, 26% of the systems reported having difficulties with EMS transport and finances.

"Itís essential to get competing hospitals and separate EMS agencies within a community to work as a team to provide optimal care for heart attack patients," James G. Jollis, MD, the studyís lead author and professor of medicine at Duke University Medical Center in Durham, N.C., said in the news release. "These study findings can serve as a benchmark and lessons learned as additional communities across the country create their own systems of coordinated, integrated, evidence-based care for STEMI patients."

PCI hospitals (84%) and/or cardiology practices (23%) provided funding for most of the systems. More than 580 community-based STEMI systems are now registered in Mission: Lifeline, covering more than 60% of the U.S. population, according to the news release.

The American Heart Associationís Mission: Lifeline Heart Attack Referring/Receiving Center Accreditation program recognizes hospitals for quickly and appropriately treating MI patients. Ten hospitals have been accredited to date, with more applications under consideration. About 200 hospitals also receive recognition awards each year for meeting certain performance criteria.

"Since Mission: Lifeline launched, weíve seen major improvements in the coordinated care of heart attack patients," Christopher Granger, MD, the studyís coauthor and chairman of the Mission: Lifeline STEMI advisory working group and professor of medicine at Duke University Medical Center, said in the news release. "Paramedics are making the STEMI diagnosis earlier, patients are being transported or transferred to appropriate hospitals more quickly and blocked arteries are being opened faster — all translating to more lives saved."

Using the survey as a snapshot, success can be improved upon even more to ensure all patients are getting the recommended best practices in STEMI care, Granger said.

The study appeared May 22 on the website of Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal. To download a PDF of the study, visit http://bit.ly/Lg0NTk.

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