Background— The success of prehospital triage protocols for patients with ST-elevation myocardial infarction (STEMI) will depend, in part, on how patients are geographically distributed around hospitals that perform percutaneous coronary intervention (PCI). Accordingly, we determined the proportion of the adult population in the United States with timely access to PCI hospitals using driving times and distances. Methods and Results— We performed a cross-sectional study using hospital-level data from the American Hospital Association Annual Survey and Census tract-level data on adults 18 years of age or older from the 2000 United States Census. Our aims were to determine the proportion of the adult population who (1) lived within 60 minutes of a PCI hospital and (2) had additional transport times within 30 minutes if directly referred to a PCI hospital as opposed to a closer, non-PCI hospital. Median times and distances to the closest PCI hospital were 11.3 (interquartile range [IQR] 5.7 to 28.5) minutes a...

https://www.lifeflightmaine.org/Documents/EMS-and-Hospitals/Research/Cardiac/Prehospital-Triage-STEMI-to-PCI-Circ-2006.aspx

Driving times and distances to hospitals with percutaneous coronary intervention in the United States: implications for prehospital triage of patients with ST-elevation myocardial infarction.

Understanding and addressing the unique health needs of people residing in rural America is critical to the American Heart Association's pursuit of a world with longer, healthier lives. Improving the health of rural populations is consistent with the American Heart Association's commitment to health equity and its focus on social determinants of health to reduce and ideally to eliminate health disparities. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders to make rural populations a priority in programming, research, and policy. This advisory first summarizes existing data on rural populations, communities, and health outcomes; explores 3 major groups of factors underlying urban-rural disparities in health outcomes, including individual factors, social determinants of health, and health delivery system factors; and then proposes a set of solutions spanning health system innovation, policy, and research aimed at improving rural health.

Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association.

Although evidence suggests that primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in the majority of patients with ST-segment–elevation myocardial infarction (STEMI), only a minority of patients with STEMI are treated with primary PCI, and of those, only a minority receive the treatment within the recommended 90 minutes after entry into the medical system. Market research conducted by the American Heart Association revealed that those involved in the care of patients with STEMI recognize the multiple barriers that prevent the prompt delivery of primary PCI and agree that it is necessary to develop systems or centers of care that will allow STEMI patients to benefit from primary PCI. The American Heart Association will convene a group of stakeholders (representing the interests of patients, physicians, emergency medical systems, community hospitals, tertiary hospitals, and payers) and quality-of-care and outcomes experts to identify the gaps between the existing and ide...

/pdf/recommendation-to-develop-strategies-to-increase-the-number-4qg7jiytno.pdf

Recommendation to Develop Strategies to Increase the Number of ST-Segment–Elevation Myocardial Infarction Patients With Timely Access to Primary Percutaneous Coronary Intervention

Rationale for establishing regional ST-elevation myocardial infarction receiving center (SRC) networks

The establishment of ST-elevation myocardial infarction (STEMI) systems of care that are intended to increase timely access to primary percutaneous coronary intervention (PCI) will affect the US healthcare system in a broad and fundamental way. The key reason for establishing STEMI systems of care is that although primary PCI is superior to fibrinolytic therapy when performed rapidly, timely access to primary PCI is currently limited. By establishing these systems, it is believed that patients with STEMI can be directed to PCI-capable hospitals through prehospital emergency medical services (EMS) protocols and emergency interhospital transfer arrangements, and as a consequence, outcomes will be improved. The establishment of STEMI systems of care in the United States will be challenging, however, and their success will be predicated on the ability to overcome a number of practical barriers.1 In this article, we discuss several of these barriers, as well as the potential for STEMI systems of care to reduce mortality and their overall implications for the US healthcare system.

The overall benefit of directing patients with STEMI to PCI-capable hospitals with prehospital EMS protocols or interhospital transfer arrangements has not been demonstrated definitively in the United States and raises concerns from a clinical perspective that need to be considered. First, the inherent delays required for performing primary PCI may limit its effectiveness when long transport times are anticipated and may influence the choice between reperfusion therapies.2–5 Thus, STEMI systems of care that divert patients to PCI-capable hospitals may delay the delivery of reperfusion therapy for many patients compared with prompt treatment with fibrinolytic therapy at the closest hospital. At some point, the additional time required to perform primary PCI will eliminate its advantages over fibrinolytic therapy, and in some scenarios it could lead to higher mortality rates. Some studies suggest that primary PCI …

/pdf/development-of-systems-of-care-for-st-elevation-myocardial-2jxrt7gjv5.pdf

Development of Systems of Care for ST-Elevation Myocardial Infarction Patients Gaps, Barriers, and Implications

With the many advances in rapid reperfusion therapy for management of acute ST segment elevation myocardial infarction (STEMI), there is a need to revisit the current plan for prehospital triage (point of entry). Until recently in Boston, and nationwide, there has been a policy that patients

Implications of the mechanical (PCI) vs thrombolytic controversy for ST segment elevation myocardial infarction on the organization of emergency medical services: the Boston EMS experience.

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Implications of the mechanical (PCI) vs thrombolytic controversy for ST segment elevation myocardial infarction on the organization of emergency medical services: the Boston EMS experience.