Clinical InvestigationAcute Ischemic Heart DiseaseDeveloping an ST-elevation myocardial infarction system of care in Dallas County
Section snippets
Eligibility and participation requirements
This research was funded by the W.W. Caruth, JR. Foundation/Communities Foundation of Texas. To implement a STEMI system of care in Dallas County, the AHA served as the organizing body and established a volunteer stakeholder group of representatives from hospitals and EMS agencies in the County. This was a 3-year program to organize a STEMI system supported by PCI hospitals and EMS agencies in Dallas County. Institutions eligible to participate in the project were restricted to those
Patient demographics
There were 3,853 AMI cases in Dallas County identified in the NCDR database from October 2010 through March 2012. Of these, 926 were nontransfer patients with STEMI who received primary PCI. Descriptive statistics of patient demographics and other control variables are presented in Table II.
Figure 1 shows the median times for the dependent variables, which are presented by quarter. Overall median D2B andS2B times for nontransfer patients with STEMI who received primary PCI decreased throughout
Discussion
The AHACI provided an opportunity to develop and improve a coordinated system of STEMI care in a large metropolitan area. The primary purpose of this research was to describe the preliminary results for the first 18 months of the project (which includes D2B and S2B times). Specifically, we sought to determine whether or not one integrated system of STEMI protocols and procedures for all participating PCI hospitals and EMS agencies in Dallas, along with feedback of performance metrics to these
Disclosures
This study was funded by the W.W. Caruth, Jr. Foundation/Communities Foundation of Texas.
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Cited by (17)
Regional Systems of Care in ST Elevation Myocardial Infarction
2021, Interventional Cardiology ClinicsCitation Excerpt :In Dallas, the effort at regionalization included financial incentives to non–PCI-capable and PCI-capable hospitals as well as EMS agencies for participation. Their efforts resulted in shorter D2B over a 2-year period.38 In Los Angeles, regionalization of STEMI care was driven by the Los Angeles County EMS Agency, which directs prehospital services for one of the country’s largest municipalities both geographically and by census.
Implementation of Regional ST-Segment Elevation Myocardial Infarction Systems of Care: Successes and Challenges
2016, Interventional Cardiology ClinicsCitation Excerpt :The program expanded to then include all hospitals in North Carolina (21 PCI-capable, and 98 PCI noncapable), thus demonstrating the feasibility of regionalizing STEMI care to an entire state (Fig. 2).22 Early adopters in predominately urban US STEMI systems of care include Los Angeles and Dallas.23,24 Table 1 compares the Minneapolis, North Carolina, Los Angeles, and Dallas systems, and the 16-region American Heart Association (AHA) Accelerator Program, which aimed to rapidly implement systems of care across multiple STEMI networks (discussed in more detail later).25,26
Alexithymia affects the time from symptom onset to calling the emergency system in STEMI patients referred for primary PCI
2016, International Journal of CardiologyCitation Excerpt :Current care systems for STEMI, designed to optimize the interaction between the Emergency Medical System (EMS) and the interventional hospitals, have led to a progressive and significant improvement in time between initial medical contact to primary angioplasty [3–4]. Despite this major progress, many patients continue to show prolonged time from the symptom onset to reperfusion [4–6], as STEMI programs do not address the patient decision making, a major component of the overall ischemic time. Reducing the patient delay is thus a critical step to further shorten ischemic time and improve clinical outcomes.
Evolution of the interventional reperfusion strategy and reperfusion times in acute ST-segment elevation myocardial infarction
2015, Annales de Cardiologie et d'AngeiologieEmergency Medical Services as a Strategy for Improving ST-Elevation Myocardial Infarction System Treatment Times
2014, Journal of Emergency MedicineCitation Excerpt :This study is one of the first to systematically measure and analyze total systemic treatment time from symptom onset through reperfusion, and we believe that strengthening our ability to consistently define and measure symptom onset times will help drive improved clinical diagnosis and treatment. Greater details establishing the validity of the metric are described elsewhere (21). Regardless, we also explored D2B as our primary dependent variable, because this metric is more established and widely reported.
Types and effects of feedback for emergency ambulance staff: A systematic mixed studies review and meta-analysis
2023, BMJ Quality and Safety
Kim A. Eagle, MD served as guest editor for this article.