STEMI SYSTEMS OF CARE STEMI Systems of Care

STEMI SYSTEMS OF CARE STEMI Systems of Care – Update on Mission: Lifeline: We are Better – Are the Patients as Well? Alice K. Jacobs, M. D. Boston University Medical Center Boston, MA

Disclosure Information FINANCIAL DISCLOSURE: Research Support: Abbott Vascular UNLABELED/UNAPPROVED USES DISCLOSURE: None

STEMI SYSTEMS OF CARE • May 30, 2007 Conference Proceedings published in Circulation and Mission: Lifeline Launched

STEMI SYSTEMS OF CARE Developing Systems of Care for STEMI

STEMI SYSTEMS OF CARE Trained AHA field staff in Mission: Lifeline implementation in July 2008 (over 350 staff from all over the United States)

STEMI SYSTEMS OF CARE Mission: Lifeline Staff

STEMI SYSTEMS OF CARE Establishing Local Initiatives Task force members: • Patients and care givers • Physicians, nurses and other providers • Payers • EMS • PCI capable and non-PCI capable hospitals • Department of Health • Rural health association • Quality improvement organizations • State and local policymakers

STEMI SYSTEMS OF CARE AHA Model Legislation: HEart Attack Response and Treatment Act (HEART Act) Section 3. A Statewide System for Heart Attack Response and Treatment • Must be consistent with ACC/AHA guidelines • Must have a community perspective • Components • Hospital • Classification • EMS • Equipment and training • Transport and transfer • Continuous quality improvement • Data collection and analysis • ACTION Registry – Get With The Guidelines

STEMI SYSTEMS OF CARE State Legislative and Regulatory Actions • Missouri – In 2008, first state law that specifically addresses creation of STEMI system of care – Time Critical Diagnosis • • • STEMI and Stroke Hospital designation Assess capacity of EMS Establish protocols Establish regions for coordination of care Promote development of regional plans

STEMI SYSTEMS OF CARE State Legislative and Regulatory Actions • In 2010, Maryland enacted regulations that formally identify STEMI receiving facilities. The criteria used in Maryland are consistent with Mission: Lifeline STEMI receiving facility criteria. – Maryland’s regulations also require that these facilities use Action Registry-Get With The Guidelines as the required data collection/quality improvement tool • In 2010, Washington State enacted broad systems of care legislation to improve the continuum of care for STEMI, sudden cardiac arrest and stroke patients

STEMI SYSTEMS OF CARE Mission: Lifeline Involvement Accreditation ML Hospital Registration ML System Registration Participation Quality Improvement/ Data Analysis Recognition Examples Memorandum of Understanding Participation, Recognition, & Certification criteria available: www. americanheart/missionlifeline

STEMI SYSTEMS OF CARE Mission: Lifeline Social Networking Community http: //mlcommunity. heart. org 12

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STEMI SYSTEMS OF CARE Use of Reperfusion Therapy for STEMI ACTION Registry-GWTG DATA: July 1, 2010 – June 30, 2011 STEMI N = 34, 264 Reperfusion Not Eligible for Reperfusion Therapy N = 27, 501 (80%) No Reperfusion – No Contraindication Listed N= 4, 460 (13%) N = 2, 303 (7%) Primary PCI – 84%* Fibrinolytics – 7%* Both PCI + Lytics – 1%* * Among patients receiving reperfusion 92% of eligible patients reperfused © 2010, American Heart Association 18

STEMI SYSTEMS OF CARE % of Patients STEMI – D 2 B and D 2 N Times: ACTION-GWTG Registry

STEMI SYSTEMS OF CARE Trend in Percentage of Patients with Doorto-Balloon Time <90 Minutes Krumholz. Circulation 2011; 124: 1038 -1045.

STEMI SYSTEMS OF CARE Trend in Percentage of Patients with Doorto-Balloon Time <75 Minutes Krumholz. Circulation 2011; 124: 1038 -1045.

STEMI SYSTEMS OF CARE Distribution of Median Door-in to Door-out (DIDO) Times for 1034 Hospitals in 2009 Herrin. Arch Intern Med 2011; 171: 1879 -1886.

STEMI SYSTEMS OF CARE Outcomes in RACE PCI Hospitals First Door-to-Device < 90 Minutes Mortality Percent P=0. 002 P=0. 01 N=164 N=232 N=102 N=127 P=0. 38 N=579 N=585 Jollis. JAMA 2007; 298: 2371 -2380.

STEMI SYSTEMS OF CARE Improvement in Door-to-Balloon Time and In-hospital Mortality 2005 -2007 AHA GWTG § 101 Hospitals § N=43, 678 § Mean DTB decreased from 101 to 87 minutes, P<0. 001 Wang. Arch Intern Med 2009; 169: 1411 -1419.

STEMI SYSTEMS OF CARE Median door-to-balloon (DTB) time and In-hospital Mortality in Patients with STEMI Undergoing Primary PCI from 2003 to 2008 N=8771 Flynn Arch Intern Med 2010; 170: 1842 -1849.

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STEMI SYSTEMS OF CARE ACTION Registry® – GWTG ™ and Mission: Lifeline Hospital Participation Please note that * denotes change in data reported and new ARG fee © 2010, American Heart Association

STEMI SYSTEMS OF CARE Systems of Care for STEMI Door-in-Door -out