TY - JOUR
T1 - Regional systems of care demonstration project
AU - Jollis, James G.
AU - Al-Khalidi, Hussein R.
AU - Roettig, Mayme L.
AU - Berger, Peter B.
AU - Corbett, Claire C.
AU - Dauerman, Harold L.
AU - Fordyce, Christopher B.
AU - Fox, Kathleen
AU - Garvey, J. Lee
AU - Gregory, Tammy
AU - Henry, Timothy D.
AU - Rokos, Ivan C.
AU - Sherwood, Matthew W.
AU - Suter, Robert E.
AU - Wilson, B. Hadley
AU - Granger, Christopher B.
N1 - Funding Information:
The Regional Systems of Care Demonstration Project: Mission: Lifeline STEMI Systems Accelerator is supported by the ACTION Registry=Get With The Guidelines and education and research grants by Abiomed, Inc, AstraZeneca, Philips Healthcare, and The Medicines Company.
Publisher Copyright:
© 2016 American Heart Association, Inc.
PY - 2016/8/2
Y1 - 2016/8/2
N2 - 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.
AB - 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.
KW - catheterization
KW - myocardial infarction
KW - reperfusion
KW - survival
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UR - http://www.scopus.com/inward/citedby.url?scp=84982833985&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.115.019474
DO - 10.1161/CIRCULATIONAHA.115.019474
M3 - Article
C2 - 27482000
AN - SCOPUS:84982833985
SN - 0009-7322
VL - 134
SP - 365
EP - 374
JO - Circulation
JF - Circulation
IS - 5
ER -