This year, an estimated 1.4 million people will suffer a heart attack.
Approximately 400,000 of those victims will experience STEMI, whereby there is a complete block in blood flow to a portion of the heart. Unless the blockage in the artery is eliminated quickly to restore blood flow, the patient is at greater risk of death or debilitation. Unfortunately, approximately 30% of STEMI patients do not receive any form of treatment to restore blood flow, whether through clot-busting drugs or percutaneous coronary intervention (PCI), the latter being the preferred therapy which uses mechanical means such as stents, balloon angioplasty or surgery.
Time is muscle. The outcome of STEMI events depends greatly on the care patients receive and the timeframe in which they receive it. Through Mission: Lifeline, the American Heart Association wants to ensure that healthcare systems are able to deliver prompt and appropriate care to STEMI patients during the critical "golden hour" following their heart attack.
To make timely and appropriate care for STEMI patients the standard across this country, Mission: Lifeline has identified a number of complex challenges that must be overcome.
|These challenges involve:|
|The Patient Challenge |
A huge hurdle to creating an ideal system of care for STEMI patients is patient education. Patients and bystanders must be able to recognize the symptoms of acute myocardial infarction, commonly referred to as a heart attack. Furthermore, they must realize the urgency of responding quickly by calling
9-1-1 to activate the emergency medical services (EMS) system.
|The EMS Challenge |
Unfortunately, a minority of our nation's EMS vehicles are equipped with 12-lead electrocardiogram (ECG) machines. These 12-lead machines are critical for detecting a heart attack and more accurately differentiating between STEMI and non-STEMI events, as compared to 4-lead ECGs.
Furthermore, there are little data available on how 12-lead ECGs used by EMS are integrated into the system of care for STEMI patients... data that could be useful in developing standards of care.
|The Emergency Department Challenge |
The current process for triaging, evaluating and treating a patient suspected of STEMI who presents to the emergency department includes a large number of potentially avoidable delays.
|The Physician Challenge |
Today across the United States, primary care and specialist physicians typically work separately rather than in integrated networks in caring for STEMI patients. This is particularly true at the patients' entry into the medical system.
|The STEMI-Referral (Non-PCI) Hospital Challenge |
Only about 25% of hospitals across the country are capable of performing PCI. While non-PCI hospitals can deliver clot-busting pharmaceutical injections, STEMI patients presenting to non-PCI hospitals often must be transferred to a PCI-capable facility for optimum care.
Non-PCI hospitals are often located in rural areas and face real challenges related to distance from PCI centers. Recent data from the National Registry of Myocardial Infarction found median delays of 180 minutes from arrival at the non-PCI hospital to balloon inflation at the primary PCI-capable hospital. Only 4.2 percent of transferred patients achieved door-to-balloon times within the recommended 90-minute window. Much improvement is needed to reduce transfer times from non-PCI to PCI-capable hospitals. The longer the delay in administering PCI as opposed to pharmaceuticals, the less benefit there is of the mechanical treatment over the clot-busting drugs.
|The STEMI-Receiving (PCI-Capable) Hospital Challenge |
Recent randomized trials indicate STEMI patients who present to non-PCI hospitals experience better outcomes if they are transferred to hospitals equipped for primary PCI rather than remaining at the local hospital for fibrinolytic, or pharmaceutical, therapy. Whether the PCI-capable hospital receives STEMI patients directly as a walk-in, via EMS or by transfer from a non-PCI hospital, each presentation has opportunities for reducing time to treatment. Because of the importance of administering immediate PCI to STEMI patients, door-to-balloon time has become a National Hospital Quality Measure required by the Centers for Medicare and Medicaid Services (CMS) and The Joint Commissions (TJC).
|The Payer Challenge |
Extending revascularization to all STEMI patients who could benefit involves rethinking and restructuring how services are purchased, how payments are made and how accountability is met.
|The Policy Challenge |
There are a number of significant barriers to establishing the ideal STEMI system. Changes in policy are needed to overcome many of these obstacles that stand in the way of delivering optimal care to all STEMI patients.