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Program to coordinate regional systems to speed heart attack care

DURHAM, N.C. Competing cardiac care teams in some of the nation's most populated areas will start working together to markedly reduce the time from heart attack to treatment as part of a new program designed by cardiologists at Duke University Medical Center.

The Duke team, along with the American Heart Association (AHA), will kick-off the Regional Systems of Care Demonstration Project Mission: Lifeline STEMI Systems Accelerator program today at the Annual Emergency Cardiovascular Care Conference in Atlanta. Leaders from the 20 regions targeted for the demonstration project, including New York City, Philadelphia, Detroit, San Antonio and Phoenix, will be involved.

"The training program brings together representatives of the entire chain of care, from emergency medical response to opening closed arteries with a catheterization balloon procedure," says Christopher Granger, M.D., a Duke cardiologist and chairman of the American Heart Association's Mission: Lifeline STEMI advisory working group.

"Time delay is the enemy when it comes to salvaging the heart muscle and saving lives," Granger said. "The goal is to develop coordinated, regional systems of care that start when the 911 call comes in, include the care patients receive in the ambulance, and the treatment they undergo at hospitals to restore blood flow in blocked heart arteries."

Four times more Americans die from heart attack than from motor vehicle accidents, according to James Jollis, M.D., a Duke cardiologist who is spearheading the program with Granger and the AHA. "Traditionally, ambulances transport patients with chest pain to hospital emergency departments and rely on hospitals to diagnose and treat heart attacks. This long-established approach includes a goal of 90 minutes from hospital door to coronary artery device time."

In recent years, a new standard evolved and is now supported by national guidelines. It calls for paramedics to diagnose heart attacks in the field, and provide the necessary information to mobilize interventional cardiology teams. As a result, patients are transported directly to waiting catheterization laboratories where their blocked coronary arteries are opened within minutes of hospital arrival. Evidence shows paramedics can reliably diagnose heart attacks, and more than half of patients are treated within 60 minutes of hospital arrival. The clock now starts when the ambulance arrives at the patient in distress, not when the patient arrives at the hospital door.

The new national guidelines also embrace an accelerated approach for patients who walk into hospitals without catheterization facilities who require transfer to a second hospital for treatment. Currently, transferred patients wait an average of two hours or longer for treatment. With the new coordinated approach, hospitals and emergency medicals services implement rapid diagnosis and transfer plans, directly activating interventional cardiology teams before the patient leaves the first hospital and transporting patients in a priority "lights and sirens" mode.

The new program builds on the successful Mission: Lifeline program, which has spent the past five years helping to create systems of care for treating heart attacks in more than 60 percent of the population.

It also builds on Duke's documented success with its statewide RACE (Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments) intervention which demonstrates how systematic barriers in timely heart attack treatment can be overcome when an organized system fills the gaps between competing institutions and other healthcare entities that function independently.

"By building consensus among all primary PCI hospitals in the state, we were able to convince the majority of emergency departments and EMS systems to adopt uniform and coordinated processes for rapid diagnosis and treatment," Jollis said. "By the end of our intervention, our protocols were adopted by state regulation for all EMS agencies, and all PCI hospitals voluntarily agreed to continue sharing data and support regional care."

During the next two years, the demonstration project team will work closely with cardiologists, emergency medicine physicians, nurses, and paramedics from each region to help them implement similar, coordinated programs. Data will be collected so each region can measure their success.

Contact: Debbe Geiger
Duke University Medical Center

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