Systems of Care for STEMI Expanding in the US

Friday, May 25, 2012

The number of regional care systems able to rapidly diagnose and treat ST-segment-elevation myocardial infarction (STEMI) patients is increasing, research shows.

STEMI is the most severe form of heart attack and affects around 300,000 people in the US each year. To prevent death, it is critical to perform rapid coronary reperfusion, of which percutaneous coronary intervention (PCI) is the preferred method.

However, reperfusion therapy continues to be administered too slowly, particularly in patients undergoing hospital transfer for primary PCI.

To address this, national guidelines called for medical centers to implement reperfusion strategies to rapidly diagnose and treat STEMI. “Coronary reperfusion can be greatly accelerated by coordinated care between hospitals and emergency medical services in a region,” writes the research team in Circulation: Cardiovascular Quality and Outcomes.

For the present study, James Jollis, from Duke University Medical Center in Durham, North Carolina, and co-investigators assessed currently implemented STEMI reperfusion systems and identified practices common to system organizations.

A STEMI system was defined as an integrated group of separate entities focused on reperfusion therapy for STEMI within a geographic region that included at least one hospital that performs PCI and at least one emergency medical service agency.

Systems meeting this definition were invited to participate in a survey of 42 questions focusing on processes of care for the diagnosis, system activation, and treatment of STEMI. The survey also examined resource allocation, financial considerations, and the most significant barriers to implementing systematic care.

Between April 2008 and January 2010 a total of 381 unique systems involving 899 PCI hospitals from 47 states responded to the survey. Of these, 255 (67 %) systems involved urban regions.

The predominant funding sources for STEMI systems were PCI hospitals and/or cardiology practices.

Most systems followed standard quality procedures and policies, including accepting STEMI patients regardless of bed availability (97 %), requiring a single phone call to activate the catheterization lab for PCI treatment (92 %), permitting the emergency department physician to active the catheterization lab without consulting a cardiologist (87 %), participating in a data collection registry (84 %), and prehospital activation of the laboratory through emergency department notification without cardiology notification (78 %).

The most common barriers to system implementation were hospital and cardiology group competition (37 and 21 %, respectively), and emergency medical services transport and finances (26 %).

“It’s essential to get competing hospitals and separate emergency medical service agencies within a community to work as a team to provide optimal care for heart attack patients,” said Jollis. “These study findings can serve as a benchmark and lessons learned as additional communities across the country create their own systems of coordinated, integrated, evidence-based care for STEMI patients.”

By Nikki Withers