Top Things to Know: Systems of Care for ST-Segment–Elevation Myocardial Infarction
Published: October 13, 2021
- The introduction of Mission: Lifeline significantly increased timely access to percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI).
- In the years since, morbidity and mortality have declined, and research has led to significant developments that have broadened our concept of the STEMI system of care.
- However, significant barriers and opportunities remain. From community education to 911 activation and EMS triage, and from emergency department and interfacility transfer protocols to post-acute care, each critical juncture presents unique challenges for the optimal care of STEMI patients.
- The following are proposed nationally focused efforts to eliminate barriers in cardiac systems of care:
- Increase public awareness campaigns of heart attack signs and symptoms and the importance of calling 911.
- Develop 911 destination transport protocols by having Emergency Medical Services (EMS) agencies, Referring Hospitals and Receiving Centers work together.
- Adopt and implement prehospital Cardiac Catheterization Laboratory (CCL) activation and “Direct to Cath Lab” protocols when appropriate for STEMI Receiving Centers.
- Improve Door-In-Door-Out (DIDO) times by having STEMI Referring Hospitals and Receiving Centers work together with designated inter-facility transport providers.
- Develop and implement Regional Transfer for PCI protocols and processes.
- Present and discuss focused feedback with each member in the system of care.
- Increase participation in active regional STEMI Systems of Care including review of regional data and sharing best practices.
- Increase attention to cardiogenic shock and out-of-hospital cardiac arrest.
Citation
Jacobs AK, Ali MJ, Best PJ, Bieniarz MC, Bufalino VJ, French WJ, Henry TD, Hollowell L, Jauch EC, Kurz MC, Levy M, Patel P, Spier T, Stone RH, Tataris KL, Thomas RJ, Zègre-Hemsey JK; on behalf of the American Heart Association Advocacy Coordinating Committee. Systems of care for ST-segment–elevation myocardial infarction: a policy statement from the American Heart Association [published online ahead of print October 13, 2021]. Circulation. doi: 10.1161/CIR.0000000000001025