American Heart Association Scientific Sessions 2022, Abstract 286
Research Highlights
- A new study underscores the need for ongoing coordinated care for timely treatment of ST elevation myocardial infarction (STEMI), a type of heart attack caused by a complete blockage in a coronary artery.
- The study found significantly lower mortality for STEMI patients treated within guideline-recommended time goals.
- The data identified concerning trends across the entire episode of care for patients experiencing STEMI, including increasing delays in treatment, greater numbers of untreated patients and increasing risk-adjusted in-hospital mortality.
CHICAGO, November 6, 2022 — A new study finds that timely treatment of ST elevation myocardial infarction (STEMI), a type of heart attack caused by a complete blockage in a coronary artery, requires ongoing coordinated care between emergency departments, paramedics and primary percutaneous coronary intervention facilities, according to researchers.
These findings, presented today at the American Heart Association's Scientific Sessions 2022, are being simultaneously published in JAMA: Journal of the American Medical Association. The Scientific Sessions meeting, held in person in Chicago and virtually, Nov. 5–7, 2022, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.
To determine whether the early improvements in STEMI care associated with American Heart Association's Mission: Lifeline® program have persisted, researchers used data from the American Heart Association's Get With The Guidelines® - Coronary Artery Disease (GWTG - CAD) registry and examined 114,871 patient records from 648 hospitals from April 2018 through September 2021.
The study illustrates significantly lower mortality for patients treated within guideline-recommended time goals. However, the data identified concerning trends across the entire episode of care for patients experiencing STEMI, including increasing delays in treatment, greater numbers of untreated patients and increasing risk-adjusted in-hospital mortality.
"The study provides a strong impetus for renewed focus on STEMI systems of care," said James G. Jollis, M.D., lead author on the paper and volunteer chair of the GWTG - CAD system of care advisory group for the American Heart Association. "As a cardiologist, most of the important decisions that affect whether my heart attack patients live or die occur long before they see me. This research amplifies how the system of care relies on family members, telecommunicators, first responders, paramedics and front-line emergency department colleagues to diagnose and implement care that has the most impact on patient care and outcomes. Regional collaboration and common data systems have the potential to improve care quality and patient survival."
The reasons for the delay in STEMI care in recent years are unclear but are perhaps related in part to diminished hospital access and delayed care associated with the pandemic.
In addition, Alice K. Jacobs, M.D., FAHA, professor of medicine at the Boston University Chobanian & Avedisian School of Medicine and past volunteer president of the American Heart Association (2004-05) said, "The difficulty in providing time and space for regular multidisciplinary reviews of the metrics likely played a role. It is noteworthy that inability to sustain uninterrupted process and outcomes measurement and feedback leads to a decline in quality."
This study has several limitations, including the self-reported nature of the registry data by hospitals and missing data for approximately 8% of patients. The regression analyses in this study include only patients for whom full data were available, To the extent that missing data were not a random occurrence, these observations may be biased by the factors that led to data not being reported but is not likely to account for the very large observed mortality differences. Despite these significant limitations, these data represent one of two available contemporary registries of STEMI care in the United States that provides an overview of recent practice
The American Heart Association was directly involved in collection of data, analyses, and review and approval of the manuscript. The Association did not maintain the right to veto publication nor to control the decision regarding to which journal the paper was submitted.
