Regional Care Systems to Treat Severe Heart Attacks Improve Survival Rates
North Carolina's coordinated, regional systems for rapid care improved survival rates of patients suffering from the most severe heart attack, according to research in the American Heart Association's journal, Circulation.
Fewer ST-segment elevation myocardial infarction (STEMI) patients died when paramedics diagnosed them en route to hospitals and hospitals followed well-defined guidelines to quickly treat or transfer patients to facilities that performed artery-opening procedures, if needed. Death rates were 2.2 percent for patients treated to guideline standards and 5.7 percent for those who weren't, according to the study.
Researchers analyzed the Regional Approach to Cardiovascular Emergencies (RACE) project, which involves regional care systems supporting voluntary coordination between emergency medical services (EMS) and all hospitals with emergency departments, including competing hospitals.
"The most important care decisions for heart attack patients are made long before they get to the hospital," said James G. Jollis, MD, the study's lead author and a professor of medicine and radiology at Duke University in Durham, N.C. "These coordinated care systems should be in every single 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, when more than 7,000 patients were treated (average age 59, 30 percent women).
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 goal of Mission: Lifeline STEMI is to have patients receiving 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 emergency department 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 cath lab and most 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 got to cardiac surgery within 103 minutes of arriving at the first hospital, compared to 117 minutes prior to the system implementation.
Furthermore, specialty cardiac centers in RACE accept all patients whether or not beds are available after 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, study co-author and a cardiologist at Duke.
Building on the success of the North Carolina system, RACE investigators are working with Mission: Lifeline leaders to establish additional regional STEMI systems across the country. This program, the Mission: Lifeline STEMI Systems Accelerator demonstration project, launches this summer in 20 regions across the country.
"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," Granger said.
A complete list of RACE investigators and author disclosures are on the manuscript.
The American Heart Association's Mission: Lifeline STEMI now includes more than 580 community-based systems, covering more than 60 percent of the U.S. population. Use the Mission: Lifeline systems of care interactive map to find a STEMI system near you.