1. STEMI Systems of Care – Update on Mission: Lifeline:
We are Better – Are the Patients as Well?
Alice K. Jacobs, M.D.
Boston University Medical Center
Boston, MA

2. Disclosure Information
FINANCIAL DISCLOSURE:
Research Support: Abbott Vascular
UNLABELED/UNAPPROVED USES DISCLOSURE: None

3. May 30, 2007
Conference Proceedings published in Circulation and Mission: Lifeline Launched

4. Developing Systems of Care for STEMI

5. Trained AHA field staff in Mission: Lifeline implementation in July 2008 (over 350 staff from all over the United States)

6. Mission: Lifeline Staff6

7. Establishing Local Initiatives
Task force members:
Patients and care givers
Physicians, nurses and other providers
Payers
EMS
PCI capable and non-PCI capable hospitals
Department of Health
Rural health association
Quality improvement organizations
State and local policymakers
OPTIONAL SLIDE: slide could be used with volunteers and external partners

8. AHA Model Legislation: HEart Attack Response and Treatment Act (HEART Act)
Section 3. A Statewide System for Heart Attack Response and Treatment
Must be consistent with ACC/AHA guidelines
Must have a community perspective
Components
Hospital
Classification
EMS
Equipment and training
Transport and transfer
Continuous quality improvement
Data collection and analysis
ACTION Registry – Get With The Guidelines

9. State Legislative and Regulatory Actions
Missouri
In 2008, first state law that specifically addresses creation of STEMI system of care
Time Critical Diagnosis
STEMI and Stroke
Hospital designation
Assess capacity of EMS
Establish protocols
Establish regions for coordination of care
Promote development of regional plans 9

10. State Legislative and Regulatory Actions
In 2010, Maryland enacted regulations that formally identify STEMI receiving facilities.  The criteria used in Maryland are consistent with Mission: Lifeline STEMI receiving facility criteria.
Maryland’s regulations also require that these facilities use Action Registry-Get With The Guidelines as the required data collection/quality improvement tool
In 2010, Washington State enacted broad systems of care legislation to improve the continuum of care for STEMI, sudden cardiac arrest and stroke patients 10

11. Mission: Lifeline Involvement
Accreditation
Recognition
Examples
ML Hospital Registration
ML System Registration
Participation
Memorandum of Understanding
Quality Improvement/
Data Analysis
Participation, Recognition,
& Certification criteria available:

12. Mission: Lifeline Social Networking Community
Registration:
Every individual user will need to set up a log in and password. This is located in the middle of the welcome page. After log- in, the user will receive a welcome that states the purpose of the site.
Each new user will receive 2 welcome s, please be sure to check the spam 12 12

18. Use of Reperfusion Therapy for STEMI ACTION Registry-GWTG DATA: July 1, 2010 – June 30, 2011
No Reperfusion –
No Contraindication Listed
N = 2,303 (7%)
Not Eligible for Reperfusion Therapy
Contraindication Listed
N= 4,460 (13%)
Primary PCI – 84%*
Fibrinolytics – 7%*
Both PCI + Lytics – 1%*
92% of eligible patients reperfused
©2010, American Heart Association 18
* Among patients receiving reperfusion

19. STEMI – D2B and D2N Times: ACTION-GWTG Registry
% of Patients

20. Trend in Percentage of Patients with Door-to-Balloon Time <90 Minutes
Trend in percentage of patients with door-to-balloon (D2B) time <90 minutes over 6 years.
Krumholz. Circulation 2011;124:

21. Trend in Percentage of Patients with Door-to-Balloon Time <75 Minutes
Trend in percentage of patients with door-to-balloon (D2B) time <90 minutes over 6 years.
Krumholz. Circulation 2011;124:

22. Distribution of Median Door-in to Door-out (DIDO) Times for 1034 Hospitals in 2009
Herrin. Arch Intern Med 2011;171:

23. Outcomes in RACE PCI Hospitals
First Door-to-Device < 90 Minutes
Mortality
P=0.002
Percent
P=0.01
P=0.38
N=164
N=232
N=127
N=102
N=579
N=585
Jollis. JAMA 2007;298:

24. Improvement in Door-to-Balloon Time and In-hospital Mortality 2005-2007
AHA GWTG
101 Hospitals
N=43,678
Mean DTB decreased from 101 to 87 minutes, P<0.001
Wang. Arch Intern Med 2009;169:

25. Median door-to-balloon (DTB) time and In-hospital Mortality in Patients with STEMI Undergoing Primary PCI from 2003 to 2008
N=8771
Flynn Arch Intern Med 2010;170:

27. ACTION Registry® – GWTG ™ and Mission: Lifeline Hospital Participation
Add title and tell what astericks and angle data labels
Please note that * denotes change in data reported and new ARG fee
©2010, American Heart Association 27

28. Systems of Care for STEMI
Door-in-Door-out