Regional Systems of Care Demonstration Project: American Heart Association Mission: Lifeline STEMI Systems Accelerator.
Regional Systems of Care Demonstration Project: American Heart Association Mission: Lifeline STEMI Systems Accelerator.
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DOI：
10.1161/circulationaha.115.019474
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发表时间：
2016-08-02
期刊：
影响因子：
37.8
通讯作者：
Mission: Lifeline STEMI Systems Accelerator Project
中科院分区：
文献类型：
--
作者：
Jollis JG;Al-Khalidi HR;Roettig ML;Berger PB;Corbett CC;Dauerman HL;Fordyce CB;Fox K;Garvey JL;Gregory T;Henry TD;Rokos IC;Sherwood MW;Suter RE;Wilson BH;Granger CB;Mission: Lifeline STEMI Systems Accelerator Project
Up to 50% of patients fail to meet ST-segment elevation myocardial infarction (STEMI) guideline goals recommending a first-medical-contact (FMC)-to-device time of <90 minutes for patients directly presenting to percutaneous coronary intervention (PCI)-capable hospitals and <120 minutes for transferred patients. We sought to increase the proportion of patients treated within guideline goals by organizing coordinated regional reperfusion plans. We established leadership teams, coordinated protocols, and provided regular feedback for 484 hospitals and 1253 emergency medical service (EMS) agencies in 16 regions across the United States. Between July 2012 and December 2013, 23,809 patients presented with acute STEMI (direct to PCI hospital: 11,765 EMS-transported and 6502 self-transported; transferred: 5542). EMS-transported patients differed from self-transported patients in symptom onset to FMC time (median: 47 versus 114 minutes), incidence of cardiac arrest (10% versus 3%), shock on admission (11% versus 3%), and in-hospital mortality (8% versus 3%) (p<0.001 for all comparisons). There was a significant increase in the proportion of patients meeting guideline goals of FMC-to-device time, including those directly presenting via EMS (50% to 55%; p<0.001) and transferred patients (44% to 48%; p=0.002). Despite regional variability, the greatest gains occurred among patients in the 5 most-improved regions, increasing from 45% to 57% (direct EMS; p<0.001), and 38% to 50% (transfers; p<0.001). This Mission: Lifeline™ STEMI Systems Accelerator demonstration project represents the largest national effort to organize regional STEMI care. By focusing on FMC-to-device time, coordinated treatment protocols, and regional data collection and reporting, we were able to significantly increase the proportion of patients treated within guideline goals.
