New initiative by UNC Hospitals expedites treatment of patients having STEMI heart attacks

UNC Hospitals launched an initiative aimed at reducing the time it takes hospital staff to recognize when a patient is having a STEMI (ST elevation myocardial infarction) heart attack - the sudden and complete blockage of a heart artery - and to begin appropriate treatment. Now, encouraging results from that effort have been published as a research letter in JAMA Cardiology.

"These results show that it is possible to expedite care of these patients," said George A. Stouffer, MD, chief of cardiology at UNC Hospitals and senior author of the JAMA letter. "Our study was not large enough to determine whether these changes will result in improved survival across the country but the results are encouraging."

STEMI, an acronym for ST elevation myocardial infarction, is considered to be more serious and life-threatening than a non-STEMI heart attack, in which a coronary artery is severely narrowed but not completely blocked.

Nationwide, there are approximately 11,000 cases of STEMI each year among hospital inpatients, and about 4,300 deaths in this group.

"When patients who are in the hospital for a non-cardiac condition have a STEMI, the onset is not usually heralded by chest pain and thus health care providers may not suspect that a coronary artery has occluded," said Xuming Dai, MD, PhD, an interventional cardiologist at UNC Hospitals who was first author on the manuscript.. "As a result, the time it takes for restoration of coronary blood flow for inpatients may be much slower and more variable than it is for patients brought to a hospital emergency department because of a suspected heart attack."

One key component of the STEMI quality improvement program was empowering nurses and other non-physician health care providers to activate the response team when they suspected a patient was having a STEMI. Once activated, the team rapidly identified and triaged inpatient STEMIs, following a protocol that closely resembles the model used by paramedics and other first responders in the outpatient setting. These combined measures reduced the average time between symptom onset and the start of treatment by 72 percent.

"This is one of the first studies to identify ways to improve care of patients who have a heart attack while in the hospital," said Stouffer, who is also a member of the UNC McAllister Heart Institute. "Based on our encouraging results, Dr. Dai and Dr. Smith at UNC are coordinating a study of 17 leading hospitals around the United States that are implementing these changes. We anxiously await the results, as this would be the first study to show that the very high mortality associated with in-hospital STEMI could be reduced."