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National survey of STEMI systems identifies widespread application of interventions, common barriers to regional care
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Results of a national survey from the American Heart Association’s Mission: Lifeline STEMI program found similar characteristics and challenge with regional care systems that treat patients with STEMI.
From April 2008 to January 2010, 381 STEMI care systems (67% in urban regions) representing 899 hospitals in 47 states responded to the Mission: Lifeline survey. Systems included at least one hospital that performs percutaneous coronary intervention and one emergency medical service (EMS) group, according to a press release.
The 42-question survey focused on processes of care for the diagnosis, system activation and treatment of STEMI, as well as resource allocation, financial considerations and significant barriers to implementing systematic care.
Most systems followed standard quality procedures and policies. System characteristics identified include:
- Admitting STEMI patients at PCI hospitals even when a hospital bed is not readily available (97%).
- Requiring a single phone call to activate the cath lab (92%).
- Permitting the ED physician to activate the cath lab without consulting a cardiologist (87%).
- Allowing cath lab activation without cardiology consult prior to the patient arriving at the hospital (78%).
- Participating in a data collection registry (84%).
Competition among hospitals (37%), competition among cardiology groups (21%) and EMS transport and finances (26%) were the most common barriers to system implementation. Other barriers included a lack of data collection and feedback (18%), lack of infrastructure support and funding (16%) and lack of bed availability (16%).
PCI hospitals (84%) and cardiology practices (23%) were the predominant funding sources for STEMI systems.
“These findings serve as a benchmark to existing systems and to regions in the process of organizing care for STEMI patients and provide a foundation for the ongoing implementation of Mission: Lifeline across the country,” the researchers concluded.
Disclosure: James G. Jollis, MD, reports financial ties with Medtronic Foundation, Philips and Sanofi-Aventis. Christopher B. Granger, MD, reports financial ties with Astellas Pharma, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Novartis, Otsuka, Roche, Sanofi-Aventis and The Medicines Company.
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