1. Dallas County STEMI Market Performance Data – Analytics – Q4 2010 Jim Langabeer II, PhD Center for Emergency Research University of Texas Health Science Center

2. Overview on Project and Data Quality 2

3. American Heart Association American Heart Association Communities Foundation of Texas Communities Foundation of Texas AHA Caruth AMI System Initiative AHA Caruth AMI System Initiative Dallas Stakeholder Committee Raymond Fowler Michael Taylor Dallas Stakeholder Committee Raymond Fowler Michael Taylor UT Southwestern Dallas UT Southwestern Dallas UT Health Science Center Houston UT Health Science Center Houston AHA Caruth Volunteer Advisory Board James Langabeer AHA Caruth Volunteer Advisory Board James Langabeer EMS Resources Subcommittee Kevin Cunningham Craig White EMS Resources Subcommittee Kevin Cunningham Craig White Protocols Subcommittee Chris Chiara Mark Till Protocols Subcommittee Chris Chiara Mark Till Education Subcommittee Karen Pickard Chris Weinzapfel Education Subcommittee Karen Pickard Chris Weinzapfel Quality Improvement Subcommittee Bob Hillert Tom Tierney Quality Improvement Subcommittee Bob Hillert Tom Tierney Symposium Planning Subcommittee Jon Gardner Tami Kayea Jennifer Ledbetter Symposium Planning Subcommittee Jon Gardner Tami Kayea Jennifer Ledbetter American College of Cardiology Project Structure

4. Data collection from ACC & EMS Development of a central database Comparison of EMS to hospital patient records Data validation/integrity checks Decision Support (data analysis) of STEMI outcomes UT Health - Role

5. This is the inaugural report of the Dallas County STEMI system of care Use caution when interpreting these figures since they are strictly baseline for everybody involved! Data are for Oct 1 2010 to Dec 31 2010 Data collected from EMS agencies and hospitals (through ACC Action Registry GWTG) 5 Dallas Hospital Market

6. Overview to Methodology Our primary focus is on collecting and analyzing both pre-hospital (EMS) and hospital data for STEMI/NSTEMI in Dallas County To capture SOAR, we prefer to have complete records from time of 911 dispatch to hospital discharge We need to match EMS Hospital data, preferably using PCR or Incident # – For this quarter, we had to use DOB and incident date/hospital arrival date since Aux3 field was not widely populated 6

7. Overall Data Quality - Reminders 7 This project requires good data entry from both EMS & hospitals! We cannot identify if 10-key entry errors exist Lots of “null values”; for instance, several patients had PCI=yes, but were missing device times or dates EMS: arrival times at facility missing in many cases 24 hour time clock (e.g., 6 pm = 18:00)

8. Reporting Agencies Summary 8 OrganizationsReceivedMissing 14 hospitalsXX Carrollton, Cedar Hill, Coppell, Dallas Fire, Desoto, Duncanville, Farmers Branch, Garland, Grand Prairie, Highland Park, Irving, Lancaster, Mesquite, Richardson, Rowlett, Sachse, Seagoville, Sunnyvale, and University Park XX Wilmer, Hutchins, Glenn Heights, CareFlite –Balch Springs, Addison XX

9. Comment on EMS Data 9 Overall, we were not able to provide meaningful data analyses on most of the EMS data for Q4 due to Missing data Data quality, Issues in EMS reporting Data timing and integrity issues We expect to have this resolved for Q1 2011

10. Patient Population Q4 2010 10

11. Q4 2010 Patient Volumes 11 603 admissions in the NCDR/ACC registry 594 unique patients 15 participating hospitals (we’ve received data for 14 this quarter) 203 STEMIs noted (34% of all registry cases) 129 STEMI, PCI, non-transfer cases in total 123 Primary PCI form the population for all D2B and other timing outcomes

12. Patient Breakdown for Outcome Calculations 12 Total Cases 603 STEMI Noted 203 NSTEMI 400 To Cath. Lab 167 (82% of STEMI) No PCI 36

13. Patient Demographics 13 Demographics Total Action GWTG STEMINSTEMI Average Age64 yrs61 yrs66 yrs Male65%68%63% % Caucasian71%70%72% % Black20%19%21% % Hispanic Origin (of any race) 14%17%13% Arrived by EMS42%46%40% Figures rounded for presentation purposes

14. STEMI Patient Volumes 14

15. Transfer Patients – STEMI PCI Only

16. STEMI Key Outcome Metrics STEMI Key Outcome Metrics 1 16 1 non-transfer, STEMI, primary PCI only Median Time (minutes) SOAR195 D2B74 FMC2B131 E2B72 Time in Cath Lab21 Reperfusion Rate, PCI82%

17. SOAR Analysis – Q4 2010 Median time in Minutes 17

18. SOAR (Symptom Onset to Reperfusion) STEMI, Primary PCI, Non-Transfer 18 H1 H4 H7 H2 H3 H5 H6 H14 H12 H11 H10 H8 H13 Median TARGET

19. SOAR SOAR STEMI, Non-Transfer, Primary PCI Only % of Cases in Each time category (n=121 complete) 19

20. Door to Balloon Times STEMI, Primary PCI only, Non-Transfers Door to Balloon Times STEMI, Primary PCI only, Non-Transfers 1 20 Median

21. 21 STEMI – Dallas County D2B Outcomes Primary PCI, Non-Transfer Only H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 Most Consistently Low D2B (with least variability)

22. D2B Outcomes by Hospital 22 1Complete Cases Only (STEMI, Non-transfer, primary PCI only); 129 STEMI-PCI, 123 immediate PCI, 2 missing data) 2Data witheld on cases for confidentiality purposes

23. D2B Times D2B Times STEMI, Non-Transfer, Primary PCI Only % of Cases in Each time category (n=121 complete) 23

24. STEMI Outcomes 24 The shortest D2B time was 23 Minutes Average length of stay for all STEMI (non-transfer, primary PCI) patients was 3.6 days We had 9 deaths in the STEMI population (4.4%)