Quality of care for ST-segment elevation myocardial infarction (STEMI) appeared to improve over time in hospitals participating in the American Heart Association's (AHA) Mission: Lifeline Program.
The AHA's Mission: Lifeline Program aims to improve guideline-recommended STEMI care by developing efficient, organized, and coordinated health care systems in the community. Hospitals volunteer to participate in Mission: Lifeline. All patients with STEMI who were admitted to Mission: Lifeline hospitals from Jan. 1, 2008, to Dec. 31, 2012, were entered into the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry—Get With the Guidelines Registry, which provides data collection and evaluation for Mission: Lifeline. The current study examined prehospital and in-hospital care and outcomes from 2008 through 2012 in patients with STEMI. In-hospital adjusted mortality rates were calculated with and without cardiac arrest as a reason for delay in primary percutaneous coronary intervention (PCI). The study results were published Dec. 31 by the Journal of the American Heart Association.
Overall, 147,466 patients at 485 hospitals were included in the study. Thirty percent of patients were women, and the median age was 60 years. Over the study period, a decrease was noted in the proportion of eligible patients who did not receive reperfusion (6.2% vs. 3.3%) and fibrinolytic therapy (13.4% vs. 7.0%). The median time from symptom onset to first medical contact remained at approximately 50 minutes during the study period, while use of prehospital electrocardiography increased (45% vs. 71%). Improvements were seen over the study period in median first medical contact-to-device time for emergency medical systems transport to PCI-capable hospitals, median first door-to-device time for transfers for primary PCI, and median door-in/door-out time at non-PCI-capable hospitals (P<0.001 over the study period for all comparisons). Overall in-hospital mortality increased over the study period (5.7% vs. 6.3%). At three years and five years, adjusted mortality rates excluding patients with known cardiac arrest decreased by 14% and 25%, respectively (P<0.001).
The researchers noted that the generalizability of their findings may be limited because hospital participation in Mission: Lifeline is voluntary and that changes over time may reflect changes in patient population as well as in patient care, among other limitations. They concluded that quality of care for STEMI improved over time in Mission: Lifeline hospitals and that while in-hospital mortality improved in patients without cardiac arrest, it did not appear to improve overall as numbers of high-risk patients increased. “This highlights the need for improving system-level care for out-of-hospital cardiac arrest, an ongoing objective of Mission: Lifeline,” the researchers wrote.