Time is Critical for STEMI Patients
Though balloon angioplasty and coronary stents - metal tubes designed to prop open diseased heart arteries - offer STEMI sufferers the best survival rates, most community hospitals lack the catheterization laboratories necessary to perform the procedures.
The lack of cath labs forces many of these local hospitals to send their STEMI patients to regional hospitals equipped to handle the procedure, but the distance between hospitals often increases a patient's time to therapy above the optimal 90 minutes.
"What we've been trying to do over the past five years is to extend this latest wave of STEMI treatment advance to patients in rural areas," explains Dr. Matthew Wolff, a cardiologist at UW Hospital and Clinics and chair of the American Heart Association's Mission Lifeline. "The real goal is to treat these patients as soon as possible and open up blocked coronary arteries, limiting the amount of heart damage being done and improving long-term survival rates."
Dr. Wolff and his team have been working to reduce the time it takes to diagnose, transport and treat STEMI patients, increasing their chances for a full recovery.
Together, he and the late Dr. Darren Bean were able to set up a regional STEMI system which has improved the coordination of care between regional community hospitals and the three Madison hospitals, including UW Hospital and Clinics.
The first regional STEMI system they implemented allowed the two doctors to cut the time to therapy down on average from 180 minutes in 2005 to 120 minutes after implementation.
"It was a significant improvement, but still not considered optimal," says Dr. Wolff. "We were really limited by a lot of things, including simply geography, the distances between our hospital and these community hospitals in the region, and how fast a helicopter can fly."
Limited by these factors, they looked in another direction to further reduce time to therapy for STEMI suffers: diagnosis of the patient in the ambulance.
Diagnosing a patient before they reach a community hospital allows for earlier mobilization of the Med Flight team and allows the catheterization laboratory to be activated and ready upon a patient's arrival.
This type of STEMI treatment system was started in Dane County in 2007. Implementing it further to the rural areas surrounding Dane County has been more difficult.
"It's a huge effort in terms of coordinating this endeavor and it's also a huge hurdle financially. Many of these rural EMS systems literally equip their ambulances with money they raise at pancake breakfasts and bake sales. The telemetry equipment alone cost roughly $10,000 per ambulance," explains Dr. Wolff.
The regional STEMI system initiative has put telemetry receivers in nine regional hospitals. Now, where ambulances with the proper equipment are available, they are achieving an average 80-minute time to therapy for STEMI patients.
The current mission is to get this pre-hospitalization diagnosis system up and running for all EMS systems, local and statewide.
"Assisting us in this effort is the American Heart Association (AHA)," says Dr. Wolff. "Mission Lifeline is a nationwide project the AHA has undertaken to improve STEMI care across the nation, specifically looking at improving these time to therapy issues."
Since forming in April 2009, the Wisconsin chapter of Mission Lifeline has begun to work on statewide protocols and guidelines for STEMI, setting the stage for rural residents across the state to have access to the same quality of care as their urban counterparts.
Date Published: 09/29/2009