Expansion of a Regional ST-Segment–Elevation Myocardial Infarction System to an Entire State

Jollis, James G.; Al‐Khalidi, Hussein R.; Monk, Lisa; Roettig, Mayme L.; Garvey, J. Lee; Aluko, Akinyele; Wilson, B. Hadley; Applegate, Robert J.; Mears, Greg; Corbett, Claire C.; Granger, Christopher B.

doi:10.1161/circulationaha.111.068049

Cited by 66 publications

(50 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The authors found that use of the 911 provider reduced both time from notification to ambulance arrival and time from notification to patient arrival in the catheterization laboratory, thereby concluding that use of the 911 provider reduced door‐to‐catheterization times 27. The RACE program emphasized municipal EMS use for IFTs and demonstrated a significant reduction in all treatment time intervals 17, 18, 28…”

Section: Discussionmentioning

confidence: 99%

Regional “Call 911” Emergency Department Protocol to Reduce Interfacility Transfer Delay for Patients With ST‐Segment–Elevation Myocardial Infarction

Bosson

Baruch

French

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundWe evaluated the first‐medical‐contact‐to‐balloon (FMC2B) time after implementation of a “Call 911” protocol for ST‐segment–elevation myocardial infarction (STEMI) interfacility transfers in a regional system.Methods and ResultsThis is a retrospective cohort study of consecutive patients with STEMI requiring interfacility transfer from a STEMI referring hospital, to one of 35 percutaneous coronary intervention‐capable STEMI receiving centers (SRCs). The Call 911 protocol allows the referring physician to activate 911 to transport a patient with STEMI to the nearest SRC for primary percutaneous coronary intervention. Patients with interfacility transfers were identified over a 4‐year period (2011–2014) from a registry to which SRCs report treatment and outcomes for all patients with STEMI transported via 911. The primary outcomes were median FMC2B time and the proportion of patients achieving the 120‐minute goal. FMC2B for primary 911 transports were calculated to serve as a system reference. There were 2471 patients with STEMI transferred to SRCs by 911 transport during the study period, of whom 1942 (79%) had emergent coronary angiography and 1410 (73%) received percutaneous coronary intervention. The median age was 61 years (interquartile range [IQR] 52–71) and 73% were men. The median FMC2B time was 111 minutes (IQR 88–153) with 56% of patients meeting the 120‐minute goal. The median STEMI referring hospital door‐in‐door‐out time was 53 minutes (IQR 37–89), emergency medical services transport time was 9 minutes (IQR 7–12), and SRC door‐to‐balloon time was 44 minutes (IQR 32–60). For primary 911 patients (N=4827), the median FMC2B time was 81 minutes (IQR 67–97).ConclusionsUsing a Call 911 protocol in this regional cardiac care system, patients with STEMI requiring interfacility transfers had a median FMC2B time of 111 minutes, with 56% meeting the 120‐minute goal.

show abstract

Section: Discussionmentioning

confidence: 99%

Regional “Call 911” Emergency Department Protocol to Reduce Interfacility Transfer Delay for Patients With ST‐Segment–Elevation Myocardial Infarction

Bosson

Baruch

French

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…46 Implementation of STEMI care systems has been associated with significant improvement in overall use and timeliness of reperfusion. 47,48 A PCI-based strategy implemented through a comprehensive systems approach has thus far been associated with reduced mortality outside 49,50 but not within the United States. 15 The ongoing regional systems of care demonstration project: Mission: Lifeline STEMI Systems Accelerator project designed in collaboration with the AHA to implement STEMI care systems in 17 major metropolitan regions encompassing >1500 emergency medical service agencies and 450 US hospitals will provide further data on the effect of regionalization of STEMI care on patient outcomes.…”

Section: Regionalization Of Stemi Carementioning

confidence: 99%

Reperfusion Strategies in Acute Coronary Syndromes

Bagai

Dangas

Stone

et al. 2014

Circulation Research

Self Cite

View full text Add to dashboard Cite

The appropriate timing of angiography to facilitate revascularization is essential to optimize outcomes in patents with ST-segment–elevation myocardial infarction and non–ST-segment–elevation acute coronary syndromes. Timely reperfusion of the infarct-related coronary artery in ST-segment–elevation myocardial infarction both with fibrinolysis or percutaneous coronary intervention minimizes myocardial damage, reduces infarct size, and decreases morbidity and mortality. Primary percutaneous coronary intervention is the preferred reperfusion method if it can be performed in a timely manner. Strategies to reduce health system–related delays in reperfusion include regionalization of ST-segment–elevation myocardial infarction care, performing prehospital ECGs, prehospital activation of the catheterization laboratory, bypassing geographically closer nonpercutaneous coronary intervention–capable hospitals, bypassing the percutaneous coronary intervention–capable hospital emergency department, and early and consistent availability of the catheterization laboratory team. With implementation of such strategies, there has been significant improvement in process measures, including door-to-balloon time. However, despite reductions in door-to-balloon times, there has been little change during the past several years in in-hospital mortality, suggesting additional factors including patient-related delays, optimization of tissue-level perfusion, and cardioprotection must be addressed to improve patient outcomes further. Early angiography followed by revascularization when appropriate also reduces rates of death, MI, and recurrent ischemia in patients with non–ST-segment–elevation acute coronary syndromes, with the greatest benefits realized in the highest risk patients. Among patients with non–ST-segment–elevation acute coronary syndromes with multivessel disease, choice of revascularization modality should be made as in stable coronary artery disease, with a goal of complete ischemic revascularization.

show abstract

“…17 All PCI and non-PCI hospitals in North Carolina participate in the RACE program, and data are collected using the National Cardiovascular Data Registry data collection tool. 18 The PreMIS database contains tools for data entry, reporting, and the evaluation of EMS quality and performance throughout North Carolina. PreMIS is an Internet-based EMS electronic patient care reporting system that serves as the electronic health care record for the documentation of delivery of EMS care.…”

Section: Design and Data Sourcesmentioning

confidence: 99%

The Impact of a Statewide Pre-Hospital STEMI Strategy to Bypass Hospitals Without Percutaneous Coronary Intervention Capability on Treatment Times

et al. 2013

Self Cite

View full text Add to dashboard Cite

Background— The ultimate treatment goal for ST-segment elevation myocardial infarction (STEMI) is rapid reperfusion via primary percutaneous intervention (PCI). North Carolina has adopted a statewide STEMI referral strategy that advises paramedics to bypass local hospitals and transport STEMI patients directly to a PCI-capable hospital, even if a non-PCI-capable hospital is closer. Methods and Results— We assessed the adherence of emergency medical services to this STEMI protocol, as well as subsequent associations with patient treatment times and outcomes by linking data from the Acute Coronary Treatment and Intervention Outcomes Network Registry ® —Get With the Guidelines ™ and a statewide emergency medical services data system from June 2008 to September 2010 for all patients with STEMI. Patients were divided into those (1) transported directly to a PCI hospital, thereby bypassing a closer non-PCI hospital and (2) first taken to a closer non-PCI center and later transferred to a PCI hospital. Among 6010 patients with STEMI, 1288 were eligible and included in our study cohort. Of these, 826 (64%) were transported directly to a PCI facility, whereas 462 (36%) were first taken to a non-PCI hospital and later transferred. In a multivariable model, increase in differential driving time and cardiac arrest were associated with a lesser likelihood of being taken directly to a PCI center, whereas a history of PCI was associated with a higher likelihood of being taken directly to a PCI center. Patients sent directly to a PCI center were more likely to have times between first medical contact and PCI within guideline recommendations. Conclusions— We found that patients who were sent directly to a PCI center had significantly shorter time to reperfusion.

show abstract

Expansion of a Regional ST-Segment–Elevation Myocardial Infarction System to an Entire State

Cited by 66 publications

References 16 publications

Regional “Call 911” Emergency Department Protocol to Reduce Interfacility Transfer Delay for Patients With ST‐Segment–Elevation Myocardial Infarction

Regional “Call 911” Emergency Department Protocol to Reduce Interfacility Transfer Delay for Patients With ST‐Segment–Elevation Myocardial Infarction

Reperfusion Strategies in Acute Coronary Syndromes

The Impact of a Statewide Pre-Hospital STEMI Strategy to Bypass Hospitals Without Percutaneous Coronary Intervention Capability on Treatment Times

Contact Info

Product

Resources

About