Study: Coordinated emergency response could help improve patient survival from heart attack

A faster, coordinated emergency response in collaboration with hospital cardiac catheterization laboratories in each U.S. region, including New York City, is associated with improving patient survival from a heart attack caused by a sudden, completely blocked artery called an ST-elevated myocardial infarction (STEMI), according to a study presented at the American Heart Association Scientific Sessions 2014.

Mount Sinai St. Luke's, Mount Sinai Roosevelt, The Mount Sinai Hospital, Mount Sinai Beth Israel, and Mount Sinai Queens were part of a 484-hospital, 16-region effort funded by the American Heart Association's (AHA) Regional Systems of Care Demonstration Project: Mission: Lifeline STEMI ACCELERATOR. The project tracked the care of more than 24,000 heart attack patients between 2012 and 2014 after implementing universal treatment protocols, data collection system, measurement, and feedback to rapidly diagnose and treat heart attack patients.

This collaboration is creating faster response for patients experiencing a STEMI heart attack that occurs when a vessel supplying blood to the heart is suddenly and completely blocked. Quickly opening the blocked artery can restore normal blood flow and minimize heart damage, but nearly half of the more than 250,000 U.S. STEMI patients each year are not treated within the recommended 90 minutes.

One main goal of the study, and the larger AHA program, is to create systems that ensure STEMI heart attack patients are treated in a cardiac catheterization laboratory within 90 minutes of first medical contact. New results of the national study show that the number of patients treated within 90 minutes has increased from 54 to 59 percent since 2012. Also, some regions improved by more than 15 percent. Additionally, the study showed shorter emergency room wait times, or even bypassing the emergency room all together, was associated with improved patient survival, and a death rate of 3.6 percent.

Jacqueline Tamis-Holland, MD, of Mount Sinai St. Luke's and Mount Sinai Roosevelt is a member of the Executive Committee for New York City's Mission Lifeline STEMI ACCELERATOR program. NYC hospitals and the Fire Department of the City of New York (FDNY) worked closely with paramedic teams to reduce the time window from when the patient called 911 to the patient's arrival in a catheterization laboratory that can open a blocked artery from STEMI.

"One of our greatest achievements was to create a protocol to send eligible patients with heart attacks directly from the ambulance to the catheterization laboratory without first stopping for their examination in the emergency room," says Dr. Tamis-Holland of Mount Sinai St. Luke's and Mount Sinai Roosevelt. "This has been very successful as a result of direct communication between the FDNY, the hospitals, and the new agreed upon protocol that certain patients should go immediately to the catheterization laboratory."

In New York City, it usually takes 55 to 60 minutes for a STEMI heart attack patient who arrives to the emergency room to have their blocked artery opened in the catheterization laboratory. As a result of this AHA project, the time it takes for the opening of a blocked STEMI artery for patients going directly to the catheterization laboratory, bypassing the emergency room, has been accomplished in less than 30 minutes after their arrival to the hospital.

"Improving heart attack patient survival is all about teamwork," says Mount Sinai's Dr. Tamis-Holland. "This team includes the dispatchers, paramedics, hospital teams, emergency room staff, and interventional cardiologists who are working together to reduce wait times in emergency rooms and speed communication to get a patient to the catheterization laboratory as fast as possible."

"Everyone needs to remember, time is muscle, including patients who may be experiencing a heart attack," says Dr. Tamis-Holland. "If you are feeling chest pain, don't hesitate, call 911."

The NYC Regional Mission: Lifeline STEMI ACCELERATOR is one of the largest systems designed to improve heart attack care in 16 metropolitan areas comprising about 10 percent of the U.S. population. The AHA created Mission: Lifeline in 2007 to bring together hospitals, emergency medical services and communities to overcome delays in treatment. Mission: Lifeline STEMI now includes 827 community-based systems, covering 82.5 percent of the U.S. population.