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

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

doi:10.1161/CIRCULATIONAHA.115.019474

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

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

Authors

James G Jollis¹, Hussein R Al-Khalidi¹, Mayme L Roettig¹, Peter B Berger¹, Claire C Corbett¹, Harold L Dauerman¹, Christopher B Fordyce¹, Kathleen Fox¹, J Lee Garvey¹, Tammy Gregory¹, Timothy D Henry¹, Ivan C Rokos¹, Matthew W Sherwood¹, Robert E Suter¹, B Hadley Wilson¹, Christopher B Granger²; Mission: Lifeline STEMI Systems Accelerator Project

Affiliations

¹ From University of North Carolina, Chapel Hill (J.G.J.); Duke Clinical Research Institute, Duke University, Durham, NC (H.R.A.-K., M.L.R., C.B.F., K.F., M.W.S., C.B.G.); Northwell Health, New Hyde Park, NY (P.B.B.); New Hanover Regional Medical Center, Wilmington, NC (C.C.C.); University of Vermont College of Medicine, Burlington (H.L.D.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); American Heart Association, Dallas, TX (T.G., R.E.S.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); UCLA-Olive View Medical Center, Los Angeles, CA (I.C.R.); and Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC (B.H.W.).
² From University of North Carolina, Chapel Hill (J.G.J.); Duke Clinical Research Institute, Duke University, Durham, NC (H.R.A.-K., M.L.R., C.B.F., K.F., M.W.S., C.B.G.); Northwell Health, New Hyde Park, NY (P.B.B.); New Hanover Regional Medical Center, Wilmington, NC (C.C.C.); University of Vermont College of Medicine, Burlington (H.L.D.); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (J.L.G.); American Heart Association, Dallas, TX (T.G., R.E.S.); Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); UCLA-Olive View Medical Center, Los Angeles, CA (I.C.R.); and Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC (B.H.W.). christopher.granger@dm.duke.edu.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

American Heart Association / organization & administration*
Death, Sudden, Cardiac
Electrocardiography
Emergency Medical Services
Emergency Service, Hospital
Guideline Adherence
Heart Arrest
Hospital Mortality
Humans
Patient Transfer
Percutaneous Coronary Intervention
Practice Guidelines as Topic
ST Elevation Myocardial Infarction / mortality
ST Elevation Myocardial Infarction / therapy*
Shock, Cardiogenic / mortality
Time-to-Treatment* / statistics & numerical data
Transportation of Patients
United States

Grants and funding

L30 HL120183/HL/NHLBI NIH HHS/United States