Enhancing AHA STEMI Treatment Guidelines When Every Minute Counts

AHA STEMI Treatment GuidelinesFor heart attack victims, every minute counts- hence the saying “time is muscle.” Experts say victims of heart attacks have better outcomes with rapid intervention to open and unclog their blocked arteries, and clinical guidelines recommend that acute heart attack patients undergo treatment within 90 minutes of arrival in the emergency room.

Recently, Emory University Hospital (EUH), Emory University Hospital Midtown (EUHM), Emory Johns Creek Hospital (EJCH) and Saint Joseph’s Hospital–all four participating Emory hospitals–received the American Heart Association Mission Lifeline Bronze Recognition award for excellence in STEMI (ST-elevation myocardial infarction) heart attack care for 2012.

A STEMI heart attack, the most severe form of heart attack, is caused when a blood clot suddenly forms, completely blocking an artery in the heart. This can result in damage that covers a large area of the heart and extends deep into the heart muscle, which is why rapid treatment is a priority to save as much heart muscle as possible. STEMI heart attack treatment options consist of percutaneous coronary intervention (PCI), which includes both angioplasty and stenting; clot-busting medication; and coronary artery bypass graft surgery (CABG).

Emory hospitals, like many other hospitals, have long participated in the “Door to Balloon time within 90 minutes” performance measure for STEMIs. Since Emory was hitting this target nearly 100% of the time, the team decided that wasn’t good enough. They decided to raise the bar for patients coming in via ambulance by starting the clock at time of “first medical contact” with the paramedics, instead of when they arrived at the hospital’s doorstep.

“We thought the clock needed to start ticking when EMS arrived and assessed the patient in the field for a STEMI,” says Abhinav Goyal, MD, MHS, associate professor of medicine in the Division of Cardiology at Emory, and director of quality for cardiology at EUH and EUHM. “Therefore, we began re-working the process with the AHA, making sure that EMS vehicles were equipped with ECG machines and all EMS personnel were trained to obtain and interpret field ECGs.” Goyal is also co-chair of the Atlanta Mission Lifeline Data Quality Subcommittee.

“It took about three years for Emory hospitals to achieve a 95 percent success rate in the Door-to-Balloon metric when we committed to it seven to eight years ago,” explains Michael Ross, Michael Ross, MD, professor of emergency medicine at Emory and co-chair of the Atlanta Mission: Lifeline Program. “But our successes came much quicker with the new First Medical Contact to Balloon performance measure. This is a true testament to the dedication and commitment of the Emory Healthcare system.”

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