EMS PRO
likely to result in death, with an in-hospital mor- tality rate of 31 percent. In contrast, some delays, like an initially negative heart attack test, had no increased risk of death.
“All delays are not cre- ated equally,” Henry said. “By identifying where the delays are we can improve the systems for transferring patients to get them the care they need,” he explained.
He said it’s important to recognize that the higher risk patients are faring the worst, so the less suc- cessful outcomes may be related to their advanced disease states.
In 2007, the Ameri- can Heart Association launched Mission: Life- line to help improve sys- tems of care for STEMI patients by reducing bar- riers from the time 9-1-1 is called until hospital discharge. That includes lack of timely access to a hospital capable of per- forming angioplasty, 24 hours a day, seven days a week.
The AHA also offers Mission: Lifeline Ac- creditation by the Society for Chest Pain Centers for hospitals meeting specific criteria as either a STEMI-receiving hos- pital or a STEMI-referral hospital.
“A study recently pub- lished in Circulation
‘Improvements in Door- to-Balloon Time in the United States, 2005 to 2010’ found that more than twice as many people are getting treat- ment within 90 minutes of arriving at an angio- plasty hospital than were five years ago, so we are making great progress,” said Chris Granger, M.D., chairman of the Mission: Lifeline steering committee and professor of medicine and direc- tor of the Cardiac Care Unit at Duke University Medical Center in Dur- ham, N.C.
“But Dr. Henry’s study shows us that many patients still have delays, and that certain types of delays are associated with worse outcomes. So there is an important opportunity to further improve care, especially for patients being trans- ferred from hospitals not equipped to do angio- plasty,” Granger added.
“Our ultimate goal is to improve timely access to angioplasty in patients with STEMI,” Henry said. “We’ve been very successful doing this in hospitals that are equipped to provide the procedure. This study emphasizes that now our focus should be on regional systems which seek to incorporate those hospitals that require patient transfer in the process,” he said. u
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