Dallas, TX - The American Heart Association (AHA) today announced the launch of a community-based initiative aimed at activating the critical chain of events necessary for opening blocked arteries [1]. The new plan, known as Mission: Lifeline, is aimed at providing better diagnosis and appropriate transport and ensuring proper care of patients with ST-segment elevation MI (STEMI).

Announcing the initiative, Dr Alice Jacobs (Boston University School of Medicine, Boston, MA), who led the work group addressing the issue of STEMI systems of care this past year, told the media that Mission: Lifeline is grounded in the stark reality of the current treatment—thrombolytic therapy or PCI—of these patients.

"Despite the proven benefits of quickly restoring blood flow to the heart muscle during a heart attack with either therapy, 30% of STEMI patients do not receive the treatment available," said Jacobs. "In addition, approximately 20% of patients are not candidates for the clot-lysing therapy, most often due to a bleeding risk. Of these patients, 70% do not receive angioplasty, even though it is the only way to open the artery. We know that among patients who receive either therapy in the United States, less than half are treated within the recommended time frames after arriving at the hospital."

The new initiative is based on the findings of experts and stakeholders who convened last year to develop a plan for improving care for STEMI, and these findings and recommendations appear online today in Circulation.

Speaking during a briefing for the media, Jacobs pointed out that primary PCI, when performed in STEMI patients in a timely manner by healthcare providers at experienced medical centers, is superior to thrombolytic therapy in reducing death and complications following MI, even when patients need to be transferred to hospitals equipped to perform PCI. Clot-busting therapy, however, is the mainstay of treatment because it is more widely available, she said. These realities, said Jacobs, fueled the work of individuals and organizations that have come together to launch the Mission: Lifeline initiative.

In March 2007, the AHA brought together patients, doctors, nurses, hospitals, emergency medical service (EMS) personnel, payers, and policy makers to review the current system of care for STEMI patients, to develop an ideal implementation system, and to identify gaps and barriers between the current and ideal system.

"For patients with STEMI, saving time saves lives," said Jacobs. "Getting STEMI patients the timely care they need involves a series of events that must flow seamlessly to be most effective."

The process, explained Jacobs, begins with educating patients to signs and symptoms of an MI, which are subtler than the public realizes, and the importance of activating EMS by calling 911 for hospital transport. More than half of STEMI patients drive themselves to the hospital or are driven by family and friends, a mistake that often results in delays in diagnosis and treatment that trained EMS personnel could provide. In addition, improving EMS diagnosis of STEMI before hospital arrival is critical to acquire, interpret, and transmit information from the 12-lead ECG. The catheterization lab could then be activated by EMS personnel from the field or by emergency physicians at the hospital who receive the ECG, said Jacobs.

For patients arriving at non-PCI hospitals, they would remain on the stretcher with EMS personnel in attendance until a decision is made about transferring them to a PCI-capable hospital. For STEMI patients who drive themselves to a non-PCI hospital, transfer to a PCI-capable hospital should take the same urgency as a 911 call, said Jacobs.

Other steps include working with payers and policy makers to ensure systems are in place for proper reimbursement and accountability protocols. A STEMI Center Certification Program with criteria for STEMI referral and receiving hospitals is also in the works. Existing regional STEMI systems of care have been implemented in Minnesota, North Carolina, and Boston, and these have served as models for Mission: Lifeline. California, Texas, and Florida are also participating in pilot programs.

Dr Tim Henry (Minneapolis Heart Institute Foundation, MN), who also spoke during the media briefing, provided information on the STEMI system of care experience in Minnesota, the largest reported experiences designed to integrate the care at non-PCI hospitals (STEMI referral) with a regional PCI-capable hospital (STEMI-receiving). A key component of their program is that emergency room physicians, or EMS personnel in some situations, can activate the system with a phone call. Using a standardized protocol, the median door-to-balloon times from the community STEMI-referral hospitals to balloon inflation in the STEMI-receiving hospital were 96 minutes in areas 60 miles from the referring hospital and 118 minutes from centers as far as 210 miles away.

"If done in standardized manner, patients can be transferred and treated in a timely manner," said Henry.

The full cost of implementing the STEMI system of care, said Jacobs, has not been assessed. The writing group noted that the system is implemented and funded at the community level, although the AHA will work with various agencies to provide expertise and to support training. The continued operation of referring hospitals, they added, is critical, and the AHA hopes Mission: Lifeline can foster a system where both the referring and receiving STEMI hospitals remain viable.