Systems of Care for ST-Segment–Elevation Myocardial Infarction: A Policy Statement From the American Heart Association

The introduction of Mission: Lifeline significantly increased timely access to percutaneous coronary intervention for patients with ST-segment–elevation myocardial infarction (STEMI). In the years since, morbidity and mortality rates 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 9-1-1 activation and emergency medical services triage and from emergency department and interfacility transfer protocols to postacute care, each critical juncture presents unique challenges for the optimal care of patients with STEMI. This policy statement sets forth recommendations for how the ideal STEMI 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.

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Taking the Reins on Systems of Care for ST-Segment–Elevation Myocardial Infarction Patients

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.117.005706 ◽

2018 ◽

Vol 11 (5) ◽

Cited By ~ 1

Author(s):

Jacqueline L. Green ◽

Alice K. Jacobs ◽

DaJuanicia Holmes ◽

Karen Chiswell ◽

Rosalia Blanco ◽

...

Keyword(s):

Myocardial Infarction ◽

Systems Of Care ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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ST-segment elevation myocardial infarction, systems of care. An urgent need for policies to co-ordinate care in order to decrease in-hospital mortality

International Journal of Cardiology ◽

10.1016/j.ijcard.2017.02.038 ◽

2017 ◽

Vol 240 ◽

pp. 82-86 ◽

Cited By ~ 1

Author(s):

Ali Osama Malik ◽

Oliver Abela ◽

Gayle Allenback ◽

Subodh Devabhaktuni ◽

Calvin Lui ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Systems Of Care ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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Implementation of Regional ST-Segment Elevation Myocardial Infarction Systems of Care

Interventional Cardiology Clinics ◽

10.1016/j.iccl.2016.06.001 ◽

2016 ◽

Vol 5 (4) ◽

pp. 415-425

Author(s):

Christopher B. Fordyce ◽

Timothy D. Henry ◽

Christopher B. Granger

Keyword(s):

Myocardial Infarction ◽

Systems Of Care ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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Association of Cardiac Care Regionalization With Access, Treatment, and Mortality Among Patients With ST-Segment Elevation Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.120.007195 ◽

2021 ◽

Vol 14 (3) ◽

Cited By ~ 1

Author(s):

Yu-Chu Shen ◽

Harlan Krumholz ◽

Renee Y. Hsia

Keyword(s):

Myocardial Infarction ◽

Systems Of Care ◽

Coronary Intervention ◽

Relative Increase ◽

Base Rate ◽

Administrative Database ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Percentage Points ◽

St Segment

Background: Regionalization of ST-segment elevation myocardial infarction (STEMI) systems of care has been championed over the past decade. Although timely access to percutaneous coronary intervention (PCI) has been shown to improve outcomes, no studies have determined how regionalization has affected the care and outcomes of patients. We sought to determine if STEMI regionalization is associated with changes in access, treatment, and outcomes. Methods: Using a difference-in-differences approach, we analyzed a statewide, administrative database of 139 494 patients with STEMI in California from 2006 to 2015 using regionalization data based on a survey of all local Emergency Medical Services agencies in the state. Results: For patients with STEMI, the base rate of admission to a hospital with PCI capability was 72.7%, and regionalization was associated with an increase of 5.34 percentage points (95% CI, 1.58–9.10), representing a 7.1% increase. Regionalization was also associated with a statistically significant increase of 3.54 (95% CI, 0.61–6.48) percentage points in the probability of same-day PCI, representing an increase of 7.1% from the 49.7% base rate and a 4.6% relative increase (2.97 percentage points [95% CI, 0.1–5.85]) in the probability of receiving PCI at any time during the hospitalization. There was a 1.84 percentage point decrease (95% CI, −3.31 to −0.37) in the probability of receiving fibrinolytics. For 7-day mortality, regionalization was associated with a 0.53 (95% CI, −1 to −0.06) percentage point greater reduction (representing 5.8% off the base rate of 9.1%) and a 1.75 percentage point decrease in the likelihood of all-cause 30-day readmission (95% CI, −3.39 to −0.11; representing 6.4% off the base rate of 27.4%). No differences were found in longer-term mortality. Conclusions: Among patients with STEMI in California from 2006 to 2015, STEMI regionalization was associated with increased access to a PCI-capable hospital, greater use of PCI, lower 7-day mortality, and lower 30-day readmissions.

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