Coordinated, regional systems for rapid care improved survival rates of patients suffering from ST-segment elevation myocardial infarction, according to a study of a North Carolina-based program.
Fewer STEMI patients died when paramedics diagnosed them en route to hospitals and hospitals followed well-defined guidelines to quickly treat or transfer patients, if needed, to facilities that performed artery-opening procedures. Death rates were 2.2% for patients treated to guideline standards and 5.7% for those who were not, according to the study. Each year, nearly 300,000 people in the United States experience a STEMI, according to background information in the study, which appeared June 4 on the website of the journal Circulation.
Researchers analyzed the Regional Approach to Cardiovascular Emergencies (RACE) project, in which regional care systems support voluntary coordination between emergency medical services and all hospitals with EDs, including competing hospitals.
"The most important care decisions for heart attack patients are made long before they get to the hospital," James G. Jollis, MD, the study’s lead author and a professor of medicine and radiology at Duke University in Durham, N.C., said in a news release. "These coordinated care systems should be in every hospital and every single EMS system in the country."
Full implementation of the RACE system involved collaboration with thousands of healthcare professionals in 119 hospitals and more than 500 EMS agencies across North Carolina. Researchers reviewed records from July 2008 to December 2009, encompassing treatment of more than 7,000 patients. Their average age was 59, and 70% were men.
The EMS technician training and hospital guidelines in RACE are based on standards established through the American Heart Association’s Mission: Lifeline STEMI program, the objective of which is for patients to receive artery-opening treatment within 90 minutes of their initial contact with the healthcare system. That first contact includes paramedics for patients who call 911 or the hospital ED for patients who use their own transportation to the hospital.
"The paramedics have the ability to identify the STEMI and, when needed, call to alert the catheterization team from the ambulance," Jollis said. "When they arrive, the patient is taken straight to the cath lab and most — 52% — are treated within 60 minutes."
The STEMI care system also outlines when and how patients are transferred if they need treatment at a hospital that provides interventional cardiac catheterization. With RACE coordinated care systems, transferred patients arrived at cardiac surgery within 103 minutes of reaching the first hospital, compared to 117 minutes before the system implementation.
Specialty cardiac centers in RACE accept all patients whether or not beds are available post-surgery.
"Our study shows coordinated regional STEMI systems save lives, no matter what unique challenges are posed by geographical or healthcare settings," said Christopher Granger, MD, the study’s coauthor and a cardiologist at Duke. "With appropriate coordination of emergency and hospital care, this system can be replicated and should be a model for the standard of care everywhere to save many more lives."
The American Heart Association’s Mission: Lifeline STEMI encompasses more than 580 community-based systems, covering more than 60% of the U.S. population. To download a PDF of the study, visit http://bit.ly/KaVXWv.
Fewer STEMI patients died when paramedics diagnosed them en route to hospitals and hospitals followed well-defined guidelines to quickly treat or transfer patients, if needed, to facilities that performed artery-opening procedures. Death rates were 2.2% for patients treated to guideline standards and 5.7% for those who were not, according to the study. Each year, nearly 300,000 people in the United States experience a STEMI, according to background information in the study, which appeared June 4 on the website of the journal Circulation.
Researchers analyzed the Regional Approach to Cardiovascular Emergencies (RACE) project, in which regional care systems support voluntary coordination between emergency medical services and all hospitals with EDs, including competing hospitals.
"The most important care decisions for heart attack patients are made long before they get to the hospital," James G. Jollis, MD, the study’s lead author and a professor of medicine and radiology at Duke University in Durham, N.C., said in a news release. "These coordinated care systems should be in every hospital and every single EMS system in the country."
Full implementation of the RACE system involved collaboration with thousands of healthcare professionals in 119 hospitals and more than 500 EMS agencies across North Carolina. Researchers reviewed records from July 2008 to December 2009, encompassing treatment of more than 7,000 patients. Their average age was 59, and 70% were men.
The EMS technician training and hospital guidelines in RACE are based on standards established through the American Heart Association’s Mission: Lifeline STEMI program, the objective of which is for patients to receive artery-opening treatment within 90 minutes of their initial contact with the healthcare system. That first contact includes paramedics for patients who call 911 or the hospital ED for patients who use their own transportation to the hospital.
"The paramedics have the ability to identify the STEMI and, when needed, call to alert the catheterization team from the ambulance," Jollis said. "When they arrive, the patient is taken straight to the cath lab and most — 52% — are treated within 60 minutes."
The STEMI care system also outlines when and how patients are transferred if they need treatment at a hospital that provides interventional cardiac catheterization. With RACE coordinated care systems, transferred patients arrived at cardiac surgery within 103 minutes of reaching the first hospital, compared to 117 minutes before the system implementation.
Specialty cardiac centers in RACE accept all patients whether or not beds are available post-surgery.
"Our study shows coordinated regional STEMI systems save lives, no matter what unique challenges are posed by geographical or healthcare settings," said Christopher Granger, MD, the study’s coauthor and a cardiologist at Duke. "With appropriate coordination of emergency and hospital care, this system can be replicated and should be a model for the standard of care everywhere to save many more lives."
The American Heart Association’s Mission: Lifeline STEMI encompasses more than 580 community-based systems, covering more than 60% of the U.S. population. To download a PDF of the study, visit http://bit.ly/KaVXWv.
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