AHA Response to The Institute of Medicine Cardiac Arrest Report Clifton Callaway, MD, PhD Chair, AHA ECC Committee

Conflicts of Interest Employed – UPMC Health System, University of Pittsburgh Grants – NHLBI, NINDS

What is ECC?

3CPR

3CPR and ECC ECC Committee Science Education Science and Programs AHA Board of Directors Science Advisory & Coordinating Committee (SACC) Manuscript Oversight Committee Council (3CPR) ECC Committee Science Education Science and Programs Systems of Care Pediatric Forum Task Forces Writing Groups

Extended ECC Volunteer Network 3CPR and ECC AHA Board of Directors Science Advisory & Coordinating Committee (SACC) Manuscript Oversight Committee Council (3CPR) ECC Committee Science Education Science and Programs Systems of Care Extended ECC Volunteer Network

What Does ECC Do? International resuscitation science consensus Guidelines & Statements Education & Training Content Public Awareness Collaboration with Advocacy Collaboration with QI International Training Strategic Alliance with Laerdal ASA Warning Signs Campaigns

Institute of Medicine Report

Institute of Medicine Consensus Study Treatment of Cardiac Arrest: Current Status & Future Directions CPR and use of AEDs EMS and hospital resuscitation systems of care National cardiac arrest statistics The state of resuscitation research in the US Next steps to significantly enhance survival rates from cardiac arrest Public meetings held March, June and August 2014 Final report published June 30, 2015 Study sponsors: AHA, Red Cross, NHLBI, CDC, ACC

Introduction The full lifesaving potential of an optimized system of care remains elusive in most communities. There are striking disparities in cardiac arrest survival, with some systems of care reporting a 5-fold difference survival. Nichol 2008, ROC Data

Call to Action To truly save as many lives as possible it will take additional novel and innovative approaches to improve outcomes Intense commitment, dedication and collaboration of countless stakeholders and partners at a national, state and local level. The successful development and implementation of solutions requires action by collaborators, partners and stakeholders. Implementation and measuring outcomes have historically been difficult Needs and gaps, such as politics, resources, leadership engagement, differ between communities and location.

AHA Supports IOM Recommendations IOM Strategies for Improving Cardiac Arrest Survival Recommendation 1 Establish a National Cardiac Arrest Registry Recommendation 2 Foster a Culture of Action Through Public Awareness and Training Recommendation 3 Enhance the Capabilities and Performance of Emergency Medical Services (EMS) Systems Recommendation 4 Set National Accreditation Standards Related to Cardiac Arrest for Hospitals & Health Care Systems Recommendation 5 Adopt Continuous Quality Improvement Programs Recommendation 6 Accelerate Research on Pathophysiology, New Therapies, and Translation of Science for Cardiac Arrest Recommendation 7 Accelerate Research on the Evaluation and Adoption of Cardiac Arrest Therapies Recommendation 8 Create a National Cardiac Arrest Collaborative AHA Supports IOM Recommendations

AHA Supports IOM Recommendations

AHA Response to IOM Cardiac Arrest Report Recommendations AHA Commitments to Increase Cardiac Arrest Survival Commitment 1 Provide funding to catalyze data interoperability. The AHA will provide up to $5 million over 5 years to incentivize and catalyze resuscitation data interoperability of existing and novel data sources into the AHA EMS Registry. Commitment 2 Actively pursue philanthropic support for local and regional implementation opportunities to increase survival by improving OHCA & IHCA systems of care. Commitment 3 Actively pursue philanthropic support to launch an AHA Resuscitation Research Network. Commitment 4 Cosponsor a “National Cardiac Arrest Summit” to facilitate the creation of a national cardiac arrest collaborative that will unify the field and identify common goals to improve survival.

IOM Recommendations and AHA Response Data

Data We Have AHA Databases CARES GWTG-R IHCA some OHCA Rapid Response Teams Mission LifeLine - Action Registry (with ACC) STEMI, some EMS Guideline Advantage Outpatient cardiology and preventitive care CARES EMS data for OHCA

http://www.heart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelines-Resuscitation

-> 5% of all 5700 hospitals in US 203 Hospitals (> 200 beds) http://www.heart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelines-Resuscitation GWTG - Resuscitation 279 Hospitals -> 5% of all 5700 hospitals in US 203 Hospitals (> 200 beds) -> 15% of 1388 US hospitals (>200 beds)

http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage

http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage

Mission LifeLine / Action Registry 1010 hospitals http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage Mission LifeLine / Action Registry 1010 hospitals -> 50% STEMI, NSTEMI

https:// mycares.net

https:// mycares.net CARES – Prehospital Database ~ 45,000 OHCA / year ~ 800 EMS agencies ~ 1700 Hospitals -> 25% OHCA

What we can do… Get your local EMS agencies into CARES (https:// mycares.net) Get your local hospital into GWTG-R or Mission Life Line Action Registry Report the “optional” out-of-hospital arrests in the GWTG data Advocate for mandatory national data warehouse…

What we can do… AHA will explore “interoperability” with major electronic health record vendors Quintiles is a company that specializes in this for GWTG for AHA QCOR has special expertise Hackathon? Council of State and Territorial Epidemiologists Talk to your local Department of Health

IOM Recommendations and AHA Response These activities are what AHA does… Guidelines, teach, promote awareness

Resuscitation Evidence Review

AHA ECC Products CPR Anytime series Family & Friends CPR Heartsaver series CPR in Schools RQI Healthcare Professional: BLS, ACLS, PALS, HeartCode Educational Science and Programs Metrics: # trained in ECC content / year # trained with real-time CPR quality feedback # enrolled in continuous training

IOM Recommendations and AHA Response Help Increase Funding

Science - Increase CA grants February submissions 2015: 47 submissions Basic = 28 Clinical + Pop = 19 Basic 18% (5) success rate Clinical 16% (3) success rate June submissions 2015: 23 submissions Basic = 10 Clinical/Pop = 13 17% success (4 funded) January Submissions 2016: 26 submissions Basic = 14 Clinical/Pop: 12+2 =14 June submissions 2016: 32 submissions Clinical + Pop:15+3 =18 ***These success rates equal or exceed the overall average success rate of 16% across AHA.

Metrics: NIH PI’s # of NIH–funded cardiac arrest Pis Goal: doubling by 2020 Data Source: NIH Reporter

$54 Funding Year

What we can do… Submit Grants Lobby for Research Funding Join You’re the Cure: Advocacy for NIH Funding! Help local investigators Stakeholder involvement is major focus of PCORI and some other new funding initiatives Communities should drive research Educational / training research needed

IOM Recommendations and AHA Response

IOM Workshop July 11-12, 2016, IOM hosted a cardiac arrest workshop to follow-on the IOM Cardiac Arrest Report. ~120 subject matter experts and stakeholders developed blueprints to address each of the 8 IOM recommendation Stakeholders are meeting now separately to advance the recommendations…. Form a “Collaborative Create a culture of action

IOM Workshop Form a “Collaborative”

IOM Workshop http://www.pulsepoint.org/download/ Create a “Culture of Action” Do not say “Bystander” anymore… Say “Layperson Rescuer” Share your skills http://www.pulsepoint.org/download/

Are YOU Missing? Join ECC – Join You’re the Cure Join AHA Send stories Send an email to Veronica Zamora (National AHA) veronica.zamora@heart.org Join You’re the Cure https:// yourethecure.org Join AHA http://my.americanheart.org And pick the “3CPR Council” as your home council Send stories https:// www.becprsmart.org