russell griffin lp, fp c - american heart associationwcm/@swa/documents/... · mission: lifeline...

Mission: Lifeline North Texas STEMI Workshop

Mission Lifeline Program InitiativeRussell Griffin LP, FP‐C

Mission: Lifeline North Texas

10/8/2014 ©2011, American Heart Association 2


Faculty Disclosure Information

Russell Griffin LP, FP‐CMission Lifeline Program Initiative

FINANCIAL DISCLOSURE: AHA Employee

UNLABELED/UNAPPROVED USES DISCLOSURE: None

©2011, American Heart Association

Welcome to the Mission: Lifeline North Texas Workshop


What is Mission: Lifeline®? Mission: Lifeline is the American Heart Association’s national

initiative to advance the systems of care for patients with ST‐segment elevation myocardial infarction (STEMI) and those resuscitated after experiencing an Out‐of‐Hospital Cardiac Arrest. The overarching goal of the initiative is to reduce mortality and morbidity for STEMI and Out of Hospital Cardiac Arrest patients and to improve their overall

quality of care

©2013, American Heart Association 4


The Uniqueness of Mission: Lifeline• Addresses the continuum of care for cardiac patients

• Emphasis is on Systems of Care

• Each participant in the system of care has a responsibility to implement process improvement initiatives

• Feedback! Feedback! Feedback!

• Involves "Co-Opetition" = Cooperation + Competition

• No one size fits all 5©2011, American Heart Association


Mission: Lifeline Guiding Principles• Patient-centered care as the #1 priority

• High-quality care that is safe, effective and timely

• Stakeholder consensus

• Increased operational efficiencies

• Appropriate incentives for quality

• Measurable patient outcomes

• An evaluation mechanism

• A role for local community hospitals

• A reduction in disparities of healthcare delivery

6©2011, American Heart Association


Barriers to Timely Access to Care (STEMI)• The patient

• Failure to promptly recognize symptoms

• Hesitation to seek medical attention

• Time to transport• Mandated delivery to the closest hospital, regardless of PCI capabilities

• Long transport in rural areas

• Decision process on arrival• Clot‐busting drugs vs. PCI

• Off hours

• Transfer to PCI facility

• Time to implement treatment strategy• Procedural factors

• Team assembly



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Acute Myocardial Infarction (AMI) Statistics• This year, ≈635,000 Americans will have an AMI and ≈280,000 will have a recurrent attack. It is estimated that an

additional 150,000 silent MIs occur each year. TOTAL: 1,065,000

• Over 340,000 of those are STEMIs

• 1 of 6 deaths (>400,000 per year) is from coronary disease

• Coronary heart disease is the single largest killer

• It is estimated that the combination of direct and indirect health care costs of coronary heart disease reached

over $195.2 billion (2009)

Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics— 2013 update: a report from the American Heart Association. Circulation. 2013;127:e6-e245.

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10©2013, American Heart Association http://www.heart.org/missionlifeline

• Early diagnosis and rapid reperfusion therapy for ST‐segment myocardial infarction (STEMI) limits infarct size and improves survival

• Door‐to‐balloon is <90 minutes in 95% of cases (non‐transfer) in ACTION Registry®‐ Get With The Guidelines™

• Current guidelines recommend reperfusion therapy within 90 minutes of first medical contact and within 120 minutes for hospital transfers

• Delay in symptom onset to treatment increases mortality

2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Circulation. 2013;127:



Statements of IDEAL EMS and Receiving Center Emergency Department STEMI Care



“The decade leading up to 2020 will continue to build upon these foundations (data systems, billing and high performance implementations), with an increased need to show our ability to provide quality service and patient care at a reasonable cost or value.” p1


Circulation. 2010:122:S787-S817

Part 10: ACS: 2010 AHA Guidelines for CPR and ECC

PCI versus Fibrinolysis consideration in the STEMI patient

• How long should the practitioner wait for PCI in a lytic eligible patient?

• When is the benefit of catheter-based therapy lost and fibrinolysis becomes the preferred option?

This paper provides the emergency physician with the total elapsed time he or she should wait for PCI, at which point the survival benefit of the invasive strategy is lost and the patient should receive a Fibrinolytic agent.

russell griffin lp, fp c - american heart associationwcm/@swa/documents/... · mission: lifeline...

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