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. 2016 Aug 2;134(5):365-74.
doi: 10.1161/CIRCULATIONAHA.115.019474.

Regional Systems of Care Demonstration Project: American Heart Association Mission: Lifeline STEMI Systems Accelerator

James G Jollis  1 , Hussein R Al-Khalidi  1 , Mayme L Roettig  1 , Peter B Berger  1 , Claire C Corbett  1 , Harold L Dauerman  1 , Christopher B Fordyce  1 , Kathleen Fox  1 , J Lee Garvey  1 , Tammy Gregory  1 , Timothy D Henry  1 , Ivan C Rokos  1 , Matthew W Sherwood  1 , Robert E Suter  1 , B Hadley Wilson  1 , Christopher B Granger  2 ; Mission: Lifeline STEMI Systems Accelerator Project
Affiliations

Regional Systems of Care Demonstration Project: American Heart Association Mission: Lifeline STEMI Systems Accelerator

James G Jollis et al. Circulation. .

Abstract

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.

Keywords: catheterization; myocardial infarction; reperfusion; survival.

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Figures

Figure 1
Figure 1
Percent of patients meeting guideline goal for FMC-to-device time by quarter. Numbers below each bar represent the total number of patients for each transportation modality for that quarter. Direct = all patients presenting directly to PCI-capable hospitals; EMS = patients presenting to PCI-capable hospitals by EMS transport; FMC = first medical contact; Transfer = patients transferred to PCI-capable hospitals; Q = quarter.
Figure 2
Figure 2
Percentage of EMS-transported patients meeting guideline goals for FMC-to-device time by quarter, 5 most-improved regions for direct EMS patients (a) and transferred patients (b) EMS = emergency medical services’ FMC = first medical contact; Q = quarter.
Figure 2
Figure 2
Percentage of EMS-transported patients meeting guideline goals for FMC-to-device time by quarter, 5 most-improved regions for direct EMS patients (a) and transferred patients (b) EMS = emergency medical services’ FMC = first medical contact; Q = quarter.
Figure 3
Figure 3
Rolling 12-month (4 quarters) moving-average of in-hospital mortality comparing AR-G patients treated in STEMI Systems Accelerator hospitals (Accelerator) versus hospitals not participating in the project (National) ACTION Registry®-Get With The Guidelines™; Q= quarter.
Figure 4
Figure 4
FMC and door-to-device times by region, 75th percentile for baseline quarter FMC = first medical contact.
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Comment in

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