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. 2016 May 20;5(5):e003392.
doi: 10.1161/JAHA.116.003392.

Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming

James R Langabeer 2nd  1 , Derek T Smith  2 , Marylou Cardenas-Turanzas  3 , Benjamin L Leonard  4 , Wendy Segrest  4 , Chris Krell  5 , Theophilus Owan  6 , Michael D Eisenhauer  7 , Daniela Gerard  8
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Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming

James R Langabeer 2nd et al. J Am Heart Assoc. .

Abstract

Background: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction; however, to be effective, PCI must be performed in a timely manner. Rural regions are at a severe disadvantage, given the relatively sparse number of PCI hospitals and long transport times.

Methods and results: We developed a standardized treatment and transfer protocol for ST-segment elevation myocardial infarction in the rural state of Wyoming. The study design compared the time-to-treatment outcomes during the pre- and postintervention periods. Details of the program, changes in reperfusion strategies over time, and outcome improvements in treatment times were reported. From January 1, 2013, to December 31, 2014, 889 patients were treated in 11 PCI-capable hospitals (4 in Wyoming, 7 in adjoining states). Given the large geographic distance in the state (median of 47 miles between patient and PCI center), 52% of all patients were transfers, and 36% were administered fibrinolysis at the referral facility. Following the intervention, there was a significant shift toward greater use of primary PCI as the dominant reperfusion strategy (from 47% to 60%, P=0.002), and the median total ischemic time from symptom onset to arterial reperfusion was decreased by 92 minutes (P<0.001). There was a similar significant reduction in median time from receiving center door to balloon of 11 minutes less than the baseline time (P<0.01).

Conclusions: Rural systems of care for ST-segment elevation myocardial infarction require increased levels of cooperation between emergency medical services agencies and hospitals. This study confirms that total ischemic times can be reduced through a coordinated rural statewide initiative.

Keywords: ST‐segment elevation myocardial infarction; outcomes research; primary percutaneous coronary intervention; quality of care; systems of care.

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Figures

Figure 1
Figure 1
Wyoming‐area facilities capable of percutaneous coronary intervention. Nebr. indicates Nebraska.
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References

    1. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK. ACC/AHA guidelines for the management of patients with ST‐elevation myocardial infarction. Circulation. 2004;110:e82–e292. - PubMed
    1. Kushner FG, Hand HM, Smith SC Jr, King SB III, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE Jr, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines . 2009 focused updates: ACC/AHA guidelines for the management of patients with ST‐elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009;120:2271–2306. - PubMed
    1. Henry TD, Gibson CM, Pinto DS. Moving toward improved care for the patient with ST‐elevation myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010;3:441–443. - PubMed
    1. Langabeer J, Prasad S, Seo M, Smith D, Segrest W, Owan T, Gerard D, Eisenhauer M. The effect of interhospital transfers, emergency medical services, and distance on ischemic time in a rural ST‐elevation myocardial infarction system of care. Am J Emerg Med. 2015;33:913–916. - PubMed
    1. Danchin N. Systems of care for ST‐segment elevation myocardial infarction: impact of different models on clinical outcomes. JACC Cardiovasc Interv. 2009;2:901–908. - PubMed

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