A few AHA-led pilot programs are already underway, Dr. Gibbons noted. A 2004 grant from The Annenberg Foundation made it possible for Los Angeles to create a response system that relies on 12-lead ECG readings by EMS providers. The AHA Greater Southeast Affiliate has convened a state-level STEMI task force and helped introduce a legislative bill to develop emergency angioplasty centers for STEMI patients. And in Texas, a task force met in January to discuss ways to more effectively manage STEMI patients.
Although establishing such a response system is an enormous challenge, the payoff is just as big, said Dr. Tim Henry, interventional cardiologist and director of research at the Minneapolis Heart Institute. Four years ago, the facility instituted a two-pronged standardized care system for STEMI patients based on their distance from a regional PCI-capable facility.
“Our approach involves different protocols for patients who live within either 60 miles [zone 1] or 60–210 miles [zone 2] from these hospitals. Our median time from the STEMI referral hospitals to balloon inflation at the receiving hospital is now 96 minutes for those in zone 1 and 118 minutes in zone 2.”
Outcomes have been very good, he said. “The in-hospital mortality for these patients is now 4%, even with 15% of them being older than 80 years. And close to 98% are getting appropriate adjunctive medication, which increases long-term survival. It's been exceptionally successful and proves that you can indeed develop these regional systems that will improve outcomes.”