1. What Have We Learned From the Mission: Lifeline Registry?
Alice K. Jacobs, M.D.
Boston University Medical Center
Boston, MA
CRT2017

2. Disclosures
I have no relevant relationships to disclose

3. Developing Systems of Care for STEMI

6. Trained AHA 350 field staff in Mission: Lifeline implementation in July 2008 (local adaptation of national recommendations)

7. Trends in Treatment and Process for STEMI Patients 2008-2012
Year
Variable
2008
2009
2010
2011
2012
Hospitals (n)
179
224
334
383
445
STEMI Patients (n)
18,583
21,670
29,886
35,683
41,644
Eligible, No reperfusion (%)*
6.2
4.4
3.3
Pre-hospital ECG (%) [direct]* 45 58 61 66 71
FMC-to-device (min) [direct]*+ 93 89 88 85 84
Door-to-device (min) [direct]*+ 68 63 60 59
First door-to-device (min)*+ [transfer]
130
122
119
114
112
Symptom onset to FMC (min)+ 50 52 49
* P<0.0001; +median minutes
Granger. AHA Scientific Sessions 2013.
Granger. AHA Scientific Sessions 2013.

8. In-hospital Mortality for STEMI Patients 2008-2012
Granger. AHA Scientific Sessions 2013.

9. Emergency Medical Services (EMS)–transported patients meeting guideline goals for FMC– to –device time for direct admission (A) and transferred (B) patients in ACCELERATOR 1.
Percentage of emergency medical services (EMS)–transported patients meeting guideline goals for first medical contact– to –device time by quarter (Q). Shown are the 5 most-improved regions for patients arriving directly to PCI hospitals by EMS (A) and transferred patients (B).
Jollis. Circulation. 2016;134:

10. ACTION Registry-GWTG Contracts &
Mission: Lifeline Participating Hospitals
2010 – 2016

11. National Number of STEMI Patients
(2012 – 2016*)
*Through Q3 2016

12. EMS First Medical Contact to
1st Device Activation
Median Times
(2012 – 2016*)
*Through Q3 2016

13. Transfers: Arrival at 1st Facility to Transfer Out (Door-In Door-Out) Median Times
(2012 – 2016*)
*Through Q3 2016

14. Transfers: Arrival at 1st Facility to 1st Device Activation
Median Times
(2012 – 2016*)
*Through Q3 2016

15. STEMI Door-to-Balloon Median Times for Transfer In and Non-Transfer In Patients
Time (min)
Transfer in DTB Times
Non-Transfer in DTB Times
ACTION Registry-GWTG DATA:
January 01, December 31, 2014

16. STEMI Primary PCI Results DTB Benchmarks for Transfer-In Patients
1st Door to Balloon < 90 Minutes
1st Door to Balloon < 120 Minutes
ACTION Registry-GWTG DATA:
January 01, December 31, 2014

17. STEMI Patients Presenting to Non-PCI Capable Hospitals in New York State (2011-12)
Treatment Received
N=10,697
PCI
CABG
Angiography Only
No PCI, CABG, Angiography

18. Non-PCI Hospital Transfer Non-PCI Hospital No Transfer
30-day mortality
PCI Hospital
N=10,697
Non-PCI Hospital All
N=3174
Non-PCI Hospital Transfer
N=2747
Non-PCI Hospital No Transfer
N=427
Elderly and African Americans and pts with heart rate ≥100 bpm, heart failure, depression, fluid and electrolyte disorders and metastatic cancer were less likely to be transferred.

19. AHA Guideline Transformation Optimization (GTO)
The GTO VISION
By 2020, transform and optimize guideline translation, adoption and use
Increase
Awareness and Understand Guidelines by HCPs
Amplify Use of Guidelines in Care Coordination & Population Health Management
Enhance Quality of Life of Patients Via Guideline Insight
Baseline, Repeatable Tracking Study & Data from Programs to Set Goals and Measure Progress

20. AHA Internal Guidelines Roll-Out Call
GTO Roadmap & Timeline
AHA Internal Guidelines Roll-Out Call
Continuous updates of Content
(ongoing)
Strategic Planning (CR, Science, Quality, Prof Ed, Patients)
Final Implementation Plans
GL updated on all AHA assets, registries, and out to key audiences
AHA Content
Development
Begins L A U N C H
8-14 months
3 months
1 month
DEVELOPMENT
& EARLY TRANSLATION
(~2yrs/6 mths)
TRANSLATION (common core mat. ~6 months)
ADOPTION
( Process from 1 yr to 10+ yrs)
18 month development time (reduced by 6 months, 50%)
Guideline to Peer Review
Guideline Release online
We are working toward simultaneous release of GL with update to AHA assets, registries and dissemination of messaging to key audiences and partner organizations
Core activation- key activities from integral business units which include: corporate relations, communications, advocacy, professional education, quality programs, meetings, publishing, patients and communications
Guideline Writing Group Kick-off
Guideline to Executive Committee
GOAL: Standardized process with core activation for all guidelines