Regional coordination speeds up STEMI treatment initiation
medwireNews: Coordinating regional reperfusion significantly increases the proportion of patients with ST-segment–elevation myocardial infarction (STEMI) treated within guideline goals, US researchers report.
In what the authors describe as “the largest effort to organize STEMI care on a regional basis ever attempted in the United States”, the This Mission: Lifeline STEMI Systems Accelerator demonstration project showed that first medical contact (FMC)–to–device times can be reduced by establishing leadership teams, coordinating protocols and providing regular feedback.
A total of 484 hospitals and 1253 emergency medical services (EMS) agencies in 16 regions across the USA implemented the treatment protocols, which included common criteria for establishing a STEMI diagnosis, catheterisation laboratory activation with a single call, treatment with simple initial regimens and patient transport by pre-identified mechanisms.
Between July 2012 and December 2013, 11,765 patients were transported by EMS and 6502 self-transported directly to percutaneous coronary intervention (PCI)-capable hospitals, while 5542 patients transferred from another facility.
During this time, there was a “modest but significant” increase in the proportion of patients meeting the FMC–to–device time goals, Christopher Granger (Duke University Medical Center, Durham, North Carolina) and colleagues report in Circulation.
Specifically, the proportion of patients who presented directly to PCI-capable hospitals and were treated within the recommended 90 minutes increased from 59% to 61% during the course of the study, while those presenting via EMS increased from 50% to 55%. The proportion within the recommended 120 minutes for transferred patients increased from 44% to 48%.
The researchers point out that there was substantial regional variation, with the five most improved regions among EMS-transported patients improving from 45% to 57%, on average, and the most improved region reporting a 20% increase, from 56% to 76%, in the number of EMS-transported patients treated according to the guidelines.
Granger and co-authors say that the variability they observed was mainly due to the speed with which regions could implement effective EMS and hospital transfer protocols.
Of note, in-hospital mortality rates in the first year of the study were comparable to those nationally, at around 6.2%. During the second year, however, in-hospital mortality fell to 5.8% at study hospitals but remained the same nationally.
“We expect these trends to continue to improve as the regional protocols are implemented on a more complete basis and become embedded as standards of care for all hospitals and EMS agencies within a region”, Granger et al remark.
They conclude that their findings “support continued efforts to implement regional ST-segment–elevation myocardial infarction networks.”
By Laura Cowen
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