Mission: Lifeline Case Studies

Updated:Jul 12,2013

A number of pilot programs are already making a difference in the speed at which STEMI patients receive appropriate care. Click to learn more about these STEMI systems of care.
 

Also note that the American Heart Association is building an online directory of STEMI systems that have registered with Mission: Lifeline. Please check the directory for systems in your area, or compete the online questionnaire to register your STEMI system.

Read below for a synopsis about the seven STEMI systems listed above, or refer to the related journal articles for more information.

Minneapolis Heart Institute, Minneapolis, Minnesota
The Minneapolis Heart Institute's Level 1 Myocardial Infarction program is designed to integrate care at STEMI referring hospitals (non-PCI) with a regional STEMI-receiving hospital (PCI capable). The program includes rural and community hospitals up to 210 miles away from the STEMI-receiving hospital.

A key component of the simple, systematic program is that emergency room physicians (or EMS personnel in some situations) can activate the system with a single phone call. In addition, a customized transfer plan was created for each non-PCI-capable hospital. The program includes training of all affiliated staff and hospital departments as well as a quality improvement program and systems to support the patient and family during the transfer process.

More than 1,345 patients have now been treated using this system, which includes 297 patients in the STEMIreceiving hospital, 627 patients in 14 hospitals up to 60 miles away (Zone 1), and 421 patients in 16 hospitals 60 to 210 miles away (Zone 2) from the STEMI-receiving hospital. Using this standardized protocol, the median door-to balloon times (from the community STEMI-referring hospitals to balloon inflation in the STEMI-receiving hospital) were 96 minutes in Zone 1 and 118 minutes in Zone 2.

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North Carolina statewide system
In North Carolina – a state that is the 10th most populated in the US with ~10 million residents and 50,000 square miles( 80% counties are rural) -- a voluntary quality assurance statewide approach to heart attack care is being used. It's called Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments (RACE).

RACE shares many features of the Minnesota model. The project incorporates integrated systems for the timely treatment and transfer (when appropriate) of patients with STEMI in five geographic regions in North Carolina and is open to all 122 acute care hospitals.   All 21 STEMI–receiving/primary PCI centers in NC agree to criteria of participation (open 24/7, no diversion, participation in the ACTION-GWTG Registry for monitoring QI, and all D2B recommendations.  Regional centers play a key role in the systems, the goal is to provide timely reperfusion to all STEMI patients emphasizing transfer to STEMI-receiving centers for primary percutaneous coronary intervention (PCI) as the preferred therapy. Due to the rural nature and lack of timely transfer in all regions, fibrinolytic therapy is administered when appropriate according to the American College of Cardiology/ American Heart Association STEMI guidelines. In essence, RACE seeks to increase the rate and speed of reperfusion. It accomplishes this improvement by moving care forward-empowering EMS and Emergency Physicians to implement destination protocols and reperfusion decisions. North Carolina STEMI systems of care allow EMS to diagnose heart attack patients (currently 76% of EMS vehicles responding to 9-1-1 chest pain calls are equipped with 12-lead ECG) and emergency department personnel to initiate treatment while improving communication, integration, and data feedback.

This project has been created with cooperation between national and regional professional societies, a local payer (Blue Cross and Blue Shield), industry and healthcare providers including EMS, emergency medicine, cardiology and hospital administrations.

For each hospital, data is collected before and after customized interventions to increase the proportion of eligible patients receiving reperfusion therapy and reduce door-to-balloon and door-to-needle times. The plan includes assessment of the impact of various features on both process and outcomes to allow refinement of strategies for improving application of reperfusion therapy.

For more information, access www.race-er.org.

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Atlanta, Georgia (T.I.M.E. Initiative)
Begun in 2006, the TIME (Timely Intervention for Myocardial Emergencies) project is one of the first urban, multihospital collaborations in the United States developed to provide rapid response to cardiac emergencies. It is a joint effort between five metro Atlanta hospitals: Atlanta Medical Center, Emory Crawford Long Hospital, Emory University Hospital, Piedmont Hospital and Saint Joseph's Hospital, in conjunction with the American Heart Association and the four EMS systems operating in Fulton County, Georgia (Grady EMS, Rural Metro EMS, Hapeville Fire Department and Atlanta Fire Department ECHO Units at Hartsfield-Jackson Atlanta International Airport).

TIME works to decrease the time between the onset of cardiac symptoms and hospital treatment by transmitting full 12-lead electrocardiogram (ECG) information from the transporting ambulance to one of the five hospitals, triggering activation of the hospital's emergency catheterization team and rapid intervention upon patient arrival.

For more information, go to http://www.dial911atlanta.com.

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Boston, Massachusetts
An urban program in Boston involves destination protocols to take STEMI patients directly to qualified PCI-capable hospitals, bypassing non-PI-capable centers. The Boston EMS has established a "point of entry" plan that directly transports STEMI patients to the nearest hospital with primary PCI capabilities.

To foster region-wide support and collaboration, the project includes an oversight committee with representation from the nine participating hospitals, and a data safety and independent monitoring board (DSMB) that includes five Boston cardiologists, one outside interventional cardiologist and one statistician.

The Boston standards for the PCI-capable hospitals include hospital volumes of at least 36 primary PCI procedures per year, performance of immediate angiography in at least 90 percent of patients transported, and door-to-balloon times of within 120 minutes in at least 75 percent of ideal patients.

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California
Established through a grant from the Annenberg Foundation in June 2004, and in partnership with the American Heart Association and the City and County of Los Angeles Fire Departments, the Wallis Annenberg HEART Program (WAHP) continues to save lives and improve the delivery of emergency cardiac care in Los Angeles.

WAHP plays the lead role not only in the implementation of the 12-Lead ECG with Los Angeles City and County paramedics, but also in the ongoing development of procedures and policies that bring the most effective emergency cardiac care to the residents of Los Angeles. This initiative has been expanded to San Diego County and a state-level task force for California has been convened to spread the success in these two counties to other areas throughout the state.

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Florida
The American Heart Association Greater Southeast Affiliate has also been engaged in a state-level STEMI task force in Florida. The activity of this task force has led to the development and introduction of a legislative bill entitled Heart Services Improvement Act. This act proposes the development of emergency PCI centers for the treatment of STEMI patients.

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Texas
The American Heart Association's Texas Affiliate began its pilot by engaging the STEMI stakeholders through a central Texas task force. This regional task force was then expanded to a statewide conference held in January 2007 to bring together stakeholders from all regions of the state to focus on ways to more effectively identify and treat STEMI patients. The meeting drew almost 250 attendees from over 60 cities throughout Texas with representation from nearly 100 hospitals and EMS systems.

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