Minutes matter: Policies to improve care for deadliest heart attacks


Date:
October 13, 2021
Source:
American Heart Association
Summary:
Converting advances in scientific knowledge and innovations in
cardiac care into improvements in patient outcomes requires
comprehensive cardiac systems of care optimize cardiac care
delivery. New recommendations support policies that standardize the
delivery of cardiac care, lower barriers to emergency care for STEMI
heart attacks, ensure patients receive care at appropriate hospitals
in a timely manner and improve access to secondary prevention and
rehabilitation and recovery resources after a heart attack.



FULL STORY ==========================================================================
The time it takes from the moment a heart attack starts to the delivery
of definitive treatment is a determining factor in a patient's ability
to survive.

The American Heart Association, the leading voluntary health organization devoted to a world of longer, healthier lives for all, today issued
public policy guidance to address systems changes for patients with the
most severe type of heart attack.


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The policy statement, "Systems of Care for ST-Segment-Elevation Myocardial Infarction (STEMI)," published today in the Association's flagship journal Circulation, sets forth recommendations for how the ideal cardiac system
of care should be designed and implemented to ensure that patients with
STEMI receive the best evidence-based care at each stage in their illness.

Improvements in cardiac systems of care are necessary to ensure scientific advances in the treatment and care of patients to improve patient
outcomes. The policy statement comes as STEMI systems of care have seen significant improvement resulting from the American Heart Association's Mission: Lifeline program, a national initiative to advance systems
of care for patients with STEMI and other acute disease states. Since
Mission: Lifeline was established in 2007, it has significantly increased timely access to percutaneous coronary intervention for patients with
STEMI, resulting in declining morbidity and mortality rates and increased research that has improved understanding of effective STEMI systems
of care.

However, significant barriers and opportunities remain that require
changes and improvements in public policy.

"We can save more lives from the most serious heart attacks, and we know
the policy changes that will allow us to do so," said Alice Jacobs,
M.D., FAHA, the statement's lead author and vice chair for clinical
affairs in the Department of Medicine at Boston University Medical
Center. "From ensuring patients suffering a heart attack can access
9-1-1 emergency services, to guaranteeing they receive needed services including EMS triage and post-acute care, policy solutions can improve
the efficiency of care protocols and save time at critical junctures to
ensure every STEMI patient has the best chance of survival." Fully 85%
of the U.S. population lives within reach of a STEMI system of care.

[1] However, 40% of patients do not call 9-1-1 and instead go to their
local emergency department.[2],[3] This can delay life-saving medical intervention by more than 30 minutes on average, decreasing the ability
of coordinated response and care across all intervention teams and
increasing the likelihood of acute heart failure or cardiac arrest.[4]
Studies show that although 41% of patients arriving at the emergency room
with chest pain/angina-equivalent symptoms receive an echocardiogram (ECG) within 10 minutes, women experience significant delays (nearly 20 minutes longer than for men). Regional STEMI systems perform better at decreasing
sex and age disparities.[5],[6],[7] "It takes our health care system an
average of nearly 20 minutes longer to provide women the same emergency
cardiac care they provide men. This is unacceptable, at a life-or-death moment," said Jessica Ze`gre-Hemsey, Ph.D., R.N. statement co-author
and associate professor of nursing at the University of North Carolina
at Chapel Hill. "Taking the best care of patients requires a strategic
policy playbook that ensures everyone on the care delivery team knows how
to maximize a patient's chances of survival and reduce health inequities."
The statement's specific policy recommendations include:
* Public Awareness and Community Education: Increase culturally
diverse
community education programs and mass communications on signs and
symptoms of heart attacks, the need to immediately call 9-1-1 and
the importance of bystander CPR.

* Entry Points and Transport: State protocols for EMS transport should
include destination practices and training for STEMI support
and EMS agencies should be engaged in quality improvement and be
represented at regional quality improvement meetings.

* Direct to Cath Lab: Improve plans for both referring and receiving
hospitals as well as transport between hospitals to collaboratively
perform evidence-based, lifesaving protocols to activate the
cardiac catheterization lab, prior to arrival when appropriate.

* Transitions in Care: Opportunities exist for improvement at each
juncture
of a patient's care, from pre-hospital care to discharge to cardiac
rehab plans and systems changes will save lives.

* Post-Heart Attack Care: Recovery care and prevention of additional
heart
attacks should be standard practice within all health care systems
and in accordance with guidelines for accountability and quality
improvement.

Health insurance plans and other third-party payers should provide
incentives for participation in cardiac rehabilitation.

* Special Considerations for Telemedicine and Rural Health: To
best reach
the 15% of people in America who are not within reach of a STEMI
system of care, particularly in rural areas, telemedicine protocols
can expedite appropriate care. Rural hospitals should collaborate
with regional STEMI receiving centers for access to expertise
and support, develop prehospital response and triage protocols
and should establish rapid interfacility transport mechanisms for
higher levels of acute care.

* Financial Considerations: There should be support for the global
reimbursement of the system of care for the patients with STEMI with
recognition of each of the components, including referring hospital,
receiving center, EMS transport and transfer and ancillary services.

This policy statement was prepared by the American Heart Association
Advocacy Coordinating Committee.

Co-authors are Alice K. Jacobs, MD, FAHA, Chair; Murtuza J. Ali, MD;
Patricia J. Best, MD; Mark C. Bieniarz, MD; Vincent J. Bufalino, MD,
FAHA; William J.

French, MD; Timothy D. Henry, MD; Lori Hollowell, MHIT, BSN, RN; Edward C.

Jauch, MD, MS, FAHA; Michael C. Kurz, MD, MS, FAHA; Michael Levy,
MD; Puja Patel, MS, MBA; Travis Spier, RN, MSN, NR-Paramedic, FP-C;
R. Harper Stone, MD; Katie L. Tataris, MD, MPH; Randal J. Thomas, MD;
and Jessica K. Ze`gre-Hemsey, PhD, RN. Authors' disclosures are listed
in the manuscript.

========================================================================== Story Source: Materials provided by American_Heart_Association. Note:
Content may be edited for style and length.


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Link to news story: https://www.sciencedaily.com/releases/2021/10/211013114034.htm

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