November 21, 2014 — A coordinated emergency response by healthcare teams to treat heart attack patients meant faster care that was associated with improved survival, according to research presented at the American Heart Association’s Scientific Sessions 2014.
The Regional Systems of Care Demonstration Project: Mission: Lifeline STEMI ACCELERATOR — one of the largest systems-of-care efforts to improve heart attack care — included 16 metropolitan areas comprising about 10 percent of the United States population. Researchers tracked more than 24,000 heart attack patients across 484 hospitals and 1,258 emergency medical services (EMS) agencies during the implementation phase of the project July 1, 2012-March 31, 2014.
Healthcare leadership teams across the regions established standard treatment protocols, a universal data collection system and ongoing measurement and feedback to rapidly diagnose and treat heart attack patients.
In the first 12 months of the project:
- Patients arriving by EMS treated within 90 minutes of first medical contact increased from 54 percent to 59 percent (p = 0.0046).
- Some regions improved more than 15 percent.
“The key to success was the collaboration between paramedics, hospital teams and interventional cardiologists working to provide care quickly,” said Christopher Granger, M.D., senior author of the study and director of the cardiac intensive care unit at Duke University Medical Center in Durham, N.C. “With in-the-field diagnosis and activation of hospital catheterization laboratories prior to hospital arrival, time spent waiting in the emergency department for the catheterization team to be available was minimized.”
Shorter emergency department (ED) times (adjusted for several covariates) were associated with improved survival (p< 0.001):
- The death rate was 3.6 percent for patients in the ED 30 minutes or less.
- The death rate increased to 7.0 percent for patients waiting in the ED 30-45 minutes.
- Those waiting in the ED longer than 45 minutes had a 10.8 percent death rate.
The project focused on ST segment elevation myocardial infarction (STEMI), the type of heart attack that occurs when a vessel supplying blood to the heart is suddenly and completely blocked. Quickly opening the blocked artery can restore normal blood flow and minimize heart damage.
Nearly half of the more than 250,000 people who have a STEMI each year in the United States aren’t treated within the recommended 90 minutes. The American Heart Association created Mission: Lifeline in 2007 to bring together hospitals, emergency medical services and communities to overcome delays in treatment. Mission: Lifeline STEMI now includes 827 community-based systems, covering 82.5 percent of the U.S. population.
The American Heart Association and regional and national leaders led the ACCELERATOR initiative, coordinated through Duke University, with the Duke Clinical Research Institute as the coordinating center.
“These findings validate the concept that the collaborative systems-of-care model we launched with our Mission: Lifeline initiative seven years ago can speed heart attack treatment and save lives,” said Alice Jacobs, M.D., AHA past president, original chair of the AHA Mission: Lifeline Advisory Working Group and professor of medicine and Vice Chair for Clinical Affairs, Department of Medicine at Boston University Medical Center. “Lessons from the demonstration project can be used to guide our future efforts to further improve heart attack care in the U.S. and beyond.”
Co-authors are James G. Jollis, M.D.; Matthew W. Sherwood, M.D., M.H.S.; Hussein R. Al-Khalidi, Ph.D.; Mayme L. Roettig, R.N. M.S.N.; Claire C Corbett, M.M.S., N.R.EMT-P.; Harold L Dauerman, M.D.; Kathleen Fox, R.N., B.S.; J. Lee Garvey, M.D.; Timothy D Henry, M.D.; Ivan C Rokos, M.D.; B. Hadley Wilson, M.D.; Author disclosures are on the manuscript.
The Medicines Company, AstraZeneca, Philips Healthcare and Abiomed funded the study.
For more information: www.heart.org