1. Brief History on Mission: Lifeline
Each year, hundreds of thousands of Americans have a
type of heart attack known as STEMI, in which blood flow is
completely blocked to a portion of the heart. Unless the
blockage is eliminated quickly, the patient’s health and life
are at serious risk. Currently, around two-thirds of STEMI
patients fail to receive the best available treatments to
restore blood flow. The American Heart Association created
MISSION:LIFELINE as a response to missed opportunities
caused by gaps in the system of care.
Every day, new systems from all areas of the United States register with Mission: Lifeline.
Because our organizations share similar missions, the AHA entered into a business agreement with the Society of Chest Pain Centers (in May of 2011) to provide Mission: Lifeline accreditation for STEMI Referring and Receiving Centers.  The goal of the combined effort is to improve the consistency of cardiac care by providing a standard approach to the treatment of STEMI patients.  The official launch of the ML accreditation program was September 2, 2011

2. WI STEMI/Mission Lifeline Projects
Eastern WI Mission Lifeline Initiative
South Central Regional STEMI Event
Potential Grant for Mission Lifeline In Western WI
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©2010, American Heart Association

3. Data Definitions
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©2010, American Heart Association

4. STEMI Definition
STEMI is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic (ECG) ST elevation and subsequent release of biomarkers of myocardial necrosis.
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©2010, American Heart Association

5. Time Points For STEMI Patients
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6. First Medical Contact
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7. Mission: Lifeline FMC to PCI
AR-G DATA Definition:
FMC – What exactly is FMC ?
Means of Transport = AMBULANCE
Pre-Arrival 1st Med Contact Date/Time = Eye to Eye contact between the STEMI patient and the 1st Medical provider to deliver (ACS) Acute Coronary Syndrome care –
12 Lead ECG
Aspirin Administration
Nitroglycerine Administration
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Moving onto the FMC measure and line items. This is a measure where the data definition is defined by ACTION and the reported measure is defined by AHA M:L.
FMC is entered into ARG and the data definition according to ARG is the Pre-Arrival 1st medical contact date and time for patients that arrive directly to the PCI Center by AMBULANCE.
This is the time EMS lays eyes on the patient.
However, if a patient presents to an Urgent Care Center or any other office where ACS care is initiated prior to the ambulance’s arrival, and then EMS is called for transport directly to the STEMI Receiving Center,
the FMC time, based on the ARG data definition, is now the time the urgent care providers laid eyes on the patient.
In ARG, there is currently no way to differentiate between EMS 1st medical contact and Urgent Care 1st medical contact.
The key here is that treatment for chest pain is started at the urgent care center or physician office. This is important to keep in mind when reviewing these patients with your customers.
If the chest pain patient reports to any office where ACS care is not initiated, such as from a dental office, and ems is summoned, then the time that is entered for Seq 3105, is when EMS makes that eye to eye contact with the patient.
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8. Opportunities for Process Improvement:
FMC looks beyond Door to Balloon
FMC applies a SYSTEM perspective to Quality and Process Improvements
The Patient, The EMS Agencies and the PCI Centers
EMS –
FMC to Pre-Hospital ECG
Pre-Hospital ECG to ED Arrival
EARLY IDENTIFICATION of the STEMI patient
EARLY ACQUISITION of the 12 Lead ECG
EARLY NOTIFICATION of the STEMI to the Receiving ED
PCI Centers -
PCI Arrival to Cath Lab
EARLY ACTIVATION of the Cath Lab Team
EARLY REPERFUSION
The FMC to PCI measure is the sum of its three main parts. When working with EMS and with each other to improve this measure, it may be beneficial to look at this measure in its parts.
FMC to Pre-Hospital ECG
Pre-Hospital ECG to ED Arrival and
ED Arrival to Cath Lab. Nationally once a patient arrives in the cath lab, the time from cath lab arrival to PCI is fairly consistent.
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9. AR-G and M:L Recognition Measure Comparison
ACTION Registry-GWTG performance achievement award requirements
Mission: lifeline receiving center recognition measures for stemi systems of care
Mission: lifeline referral center recognition measures for stemi systems of care
ASA at Arrival
DTN < 30 Minutes
DTB < 90 Minutes
ASA on Discharge
Discharge beta-blocker
Discharge ACE-I/ARB (ideal patients)
Discharge statin
Smoking Cessation
Cardiac Rehabilitation
Door to first device < 90 Minutes, non-transfer patients
FMC to first device < 90 Minutes, non-transfer patients
Eligible patients receiving any reperfusion (PCI or Lytics)
ASA within 24 hours
ASA at Discharge
Beta-blocker at Discharge
Statins or lipid lowering drugs
ACEI/ARB at discharge
Smoking Cessation
Door to first ECG time <10 Minutes
Eligible patients receiving any reperfusion (PCI or Lytics)
Door to Needle < 30 Minutes
Door In – Door Out < 45 Minutes
ASA within 24 hours
ASA at Discharge
Beta-blocker at Discharge
Statins or lipid lowering drugs
ACEI/ARB at discharge
Smoking Cessation
Now in looking in depth at the % Reperfusion measure and the FMC to PCI Measure, our hopes is that all of our Mission: Lifeline hospitals achieve Mission: Lifeline Recognition. Here in column 2 and 3 are the Mission Lifeline recognition criteria for both Receiving and Referral Centers. Every referral center that missed achieving ML recognition did not achieve at least a 75% in the Arrival to ECG < 10 minutes measure.
Mission Lifeline Achievement is offered to STEMI receiving Centers and STEMI Referral Centers using either Limited or Premier Forms.
Each measure must have at least 75% adherence. And the overall composite score must be at least 85%.
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10. Referring Hospital Education/Tools
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©2010, American Heart Association

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13. Group Discussion
How do you interact with your referring hospitals currently?
Education?
Protocols?
Data Feedback
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©2010, American Heart Association

14. Education Current Education Practices
What are the gaps in Education from the referring hospital side?
Can we collaborate state-wide to address education/barriers?
State-wide STEMI Conference
State-wide CME Webinar Series
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©2010, American Heart Association

15. Protocols
Does everyone have a STEMI and lytic protocol for their referring hospitals?
If a referring hospital sends patients to more than 1 facility, is there regional collaboration?
Sample Protocols
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19. Data Feedback 3.4.1. Regional Systems of STEMI Care, Reperfusion
How do we create an effective data feedback system between care providers?
Regional Systems of STEMI Care, Reperfusion
Therapy, and Time-to-Treatment Goals: Recommendations
See Figure 2.
Class I
1. All communities should create and maintain a regional
system of STEMI care that includes assessment and
continuous quality improvement of EMS and hospitalbased
activities. Performance can be facilitated by
participating in programs such as Mission: Lifeline
and the D2B Alliance.71,76–78 (Level of Evidence: B)
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21. Next Meeting???
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©2010, American Heart Association