Mission: Lifeline The AHA STEMI Initiative Status Report Alice K. Jacobs, M.D.

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

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 n=15,049 patients n=491 hospitals Median D-to-B 152 min < 90 min = 8.6% 36.3 26.4 17.6 8.2 4.3 3.7 2.2 1.3 < 1 1 to <2 3 to <4 5 to <6 4 to <5 6 to <7 2 to <3 > 7 Hours Chakrabarti. JACC. 2008;51:2442-2443.

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

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

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

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. 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. EMS Assessment for STEMI

11. Evaluate Existing Models Have You Registered Your STEMI System with Mission: Lifeline?? • 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

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. 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 Establishing Local Initiatives Task force members:

17. How will we measure our impact?

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

20. Not PCI capable NHAAP CDC Patient NAEMT NAEMSP NASEMSO NEMSIS ACEP American Ambulance Assn AACCN ENA CMS Aetna UnitedHealth Networks Payers EMSED AHRQ FDA JCAHO Evaluation & Outcomes STEMIReferral ACTION/GWTG NRHA SCAI Society of Chest Pain Centers ACP STS AACCN ENA Policy Makers Center of Care STEMIReceiving PCI capable CMS Adapted from Jacobs. Circulation2007;116;217-230