WI STEMIMission Lifeline Projects Eastern WI Mission Lifeline

WI STEMI/Mission Lifeline Projects • Eastern WI Mission Lifeline Initiative • South Central Regional STEMI Event • Potential Grant for Mission Lifeline In Western WI 2/27/2021 © 2010, American Heart Association 2

Data Definitions 2/27/2021 © 2010, American Heart Association 3

STEMI Definition STEMI is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic (ECG) ST elevation and subsequent release of biomarkers of myocardial necrosis. 2/27/2021 © 2010, American Heart Association 4

Time Points For STEMI Patients 2/27/2021 © 2010, American Heart Association 5

First Medical Contact 2/27/2021 © 2010, American Heart Association 6

Mission: Lifeline FMC to PCI AR-G DATA Definition: • FMC – What exactly is FMC ? • Means of Transport = AMBULANCE • Pre-Arrival 1 st Med Contact Date/Time = Eye to Eye contact between the STEMI patient and the 1 st Medical provider to deliver (ACS) Acute Coronary Syndrome care – • 12 Lead ECG • Aspirin Administration • Nitroglycerine Administration 2/27/2021 2012 AHA Mission: Lifeline 7

Opportunities for Process Improvement: • FMC looks beyond Door to Balloon • FMC applies a SYSTEM perspective to Quality and Process Improvements • The Patient, The EMS Agencies and the PCI Centers • EMS – • FMC to Pre-Hospital ECG • Pre-Hospital ECG to ED Arrival • EARLY IDENTIFICATION of the STEMI patient • EARLY ACQUISITION of the 12 Lead ECG • EARLY NOTIFICATION of the STEMI to the Receiving ED • PCI Centers • PCI Arrival to Cath Lab • EARLY ACTIVATION of the Cath Lab Team • EARLY REPERFUSION 2/27/2021 2012 AHA Mission: Lifeline 8

AR-G and M: L Recognition Measure Comparison ACTION REGISTRY-GWTG PERFORMANCE ACHIEVEMENT AWARD REQUIREMENTS MISSION: LIFELINE RECEIVING CENTER RECOGNITION MEASURES FOR STEMI SYSTEMS OF CARE MISSION: LIFELINE REFERRAL CENTER RECOGNITION MEASURES FOR STEMI SYSTEMS OF CARE • ASA at Arrival • • • DTN < 30 Minutes Door to first device < 90 Minutes, non-transfer patients Door to first ECG time <10 Minutes • DTB < 90 Minutes • • Eligible patients receiving any reperfusion (PCI or Lytics) • ASA on Discharge FMC to first device < 90 Minutes, non-transfer patients • Door to Needle < 30 Minutes • Discharge beta-blocker • • • Discharge ACE-I/ARB (ideal patients) Eligible patients receiving any reperfusion (PCI or Lytics) Door In – Door Out < 45 Minutes • ASA within 24 hours • Discharge statin • ASA at Discharge • Smoking Cessation • Beta-blocker at Discharge • Cardiac Rehabilitation • Statins or lipid lowering drugs • ACEI/ARB at discharge • Smoking Cessation 2/27/2021 2012 AHA Mission: Lifeline 9

Referring Hospital Education/Tools 2/27/2021 © 2010, American Heart Association 10

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Group Discussion • How do you interact with your referring hospitals currently? • Education? • Protocols? • Data Feedback 2/27/2021 © 2010, American Heart Association 13

Education • Current Education Practices • What are the gaps in Education from the referring hospital side? • Can we collaborate state-wide to address education/barriers? • State-wide STEMI Conference • State-wide CME Webinar Series 2/27/2021 © 2010, American Heart Association 14

Protocols • Does everyone have a STEMI and lytic protocol for their referring hospitals? • If a referring hospital sends patients to more than 1 facility, is there regional collaboration? • Sample Protocols 2/27/2021 © 2010, American Heart Association 15

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Data Feedback • How do we create an effective data feedback system between care providers? 3. 4. 1. Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals: Recommendations See Figure 2. Class I 1. All communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of EMS and hospitalbased activities. Performance can be facilitated by participating in programs such as Mission: Lifeline and the D 2 B Alliance. 71, 76– 78 (Level of Evidence: B) 2/27/2021 © 2010, American Heart Association 19

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Next Meeting? ? ? 2/27/2021 © 2010, American Heart Association 21