1. Mission: Lifeline The AHA STEMI Initiative Status Report Alice K. Jacobs, M.D. Boston University Medical Center Boston, MA There are no conflicts or relationships to disclose.

2. Community-based National initiative Improve quality of care + outcomes in STEMI Improve health care system readiness and response to STEMI. AHA’s STEMI Initiative Mission: Lifeline

3. How do we increase the number of patients with timely access to primary PCI?

4. Distribution of Total Door-to-Balloon Time in Transfer Patients in NCDR 2005-06 < 1 2 to <3 Hours Chakrabarti. JACC. 2008;51:2442-2443. 1 to <2 3 to <4 4 to <5 5 to <6 6 to <7 > 7 1.3 26.4 36.3 17.6 8.2 4.3 2.2 3.7 n=15,049 patients n=491 hospitals Median D-to-B 152 min < 90 min = 8.6%

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

6. Administrative Structure Assess EMS Systems and Strategies for Improvement Evaluate Existing Models Establish Local Initiatives Explore Possibility of National STEMI Certification Elliott Antman, MD Bob O’Conner, MD Gray Ellrodt, MD Neil Meltzer Bob Harrington, MD George Mensah, MD Eric Peterson, MD David Williams, MD

7. State Health Alliances Cultural Health Initiatives ECC State Advocacy Quality ImprovementCommunications AHA Staff Mission: Lifeline

8. EMS System Assessment and Improvement The American Heart Association is participating in a needs assessment in collaboration with EMS organizations and is analyzing the effectiveness of EMS for STEMI patients as part of a STEMI system of care.

9. Mission: Lifeline On-Line Survey www.americanheart.org/missionlifeline

10. EMS Assessment for STEMI Designed for all EMS County organizations TEST Phase from May 12 through June 6, 2008 distributed by State Health Alliance staff in eight test states: CA, DE, KS, MO, NC, PA, TX, and WY After test phase, the assessment was distributed to all fifty states via NASEMSO and other EMS organizations.

11. Evaluate Existing Models The American Heart Association will review existing local or regional STEMI Systems of Care models. - Administration - Locale (Urban, Rural) - Processes of Care - Financial Considerations - Disparities in care - Resource allocation Have You Registered Your STEMI System with Mission: Lifeline??

12. Have You Registered Your STEMI System with Mission: Lifeline? www.americanheart.org/missionlifeline

13. Have You Registered Your STEMI System with Mission: Lifeline? www.americanheart.org/missionlifeline

15. Establishing Local Initiatives The American Heart Association has convened the task force initiative at the state and local levels to identify ways to implement national recommendations for STEMI systems in local communities.

16. Establishing Local Initiatives 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 : Task force members :

17. How will we measure our impact?

19. PCI capable Non-PCI SYSTEM OF CARE CENTER OF CARE Patient EMS ED STEMI Referral STEMI Receiving Policy Makers Activate EMS Avoid delay 12-lead ECG 9-1-1 interhospital transport Activate team No diversion Consider integrated payment No penalty to patients Protocols and toolkits STEMI Center Certification Quality improvement measures Treatment protocols and clinical pathways Payer Jacobs. Circulation 2007;116:217-230.

20. PCI capable Not PCI capable Patient EMS ED STEMI Referral Payers Policy Makers STEMI Receiving NHAAP CDC NAEMT NAEMSP NASEMSO NEMSIS ACEP American Ambulance Assn AACCN ENA ACTION/GWTG NRHA SCAI Society of Chest Pain Centers ACP STS AACCN ENA CMS Aetna UnitedHealth Networks CMS Center of Care Adapted from Jacobs. Circulation 2007;116;217-230 Evaluation & Outcomes AHRQ FDA JCAHO