A coordinated statewide system for treating the deadly form of heart attack known as STEMI (ST-segment elevation myocardial infarction) is decreasing the amount of time it takes to get patients in North Carolina to treatment and perhaps increase survival rates, new research finds.
RACE-ER (Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments—Emergency Response) is the nation’s largest voluntary statewide heart attack care intervention program, according to researchers at Duke University Medical Center, who spearheaded the program. It began as a pilot program in 2007 and now includes more than 500 EMS agencies and about 200 hospitals.
The study, published in the June 4 issue of Circulation, involved data from 6,800 STEMI patients taken to 119 hospitals throughout the state from July 2008 to December 2009, including 21 PCI (percutaneous coronary intervention) centers. Time to treatment for patients who first went to a non-PCI hospital and were transferred to a PCI hospital fell from 117 to 103 minutes, while time to treatment for patients taken directly to a PCI hospital fell from 64 to 59 minutes. Prehospital ECGs performed on STEMI patients transported to PCI centers increased from 67 percent to 88 percent.
The research also suggests a trend toward lower mortality. Among patients who received PCI within the recommended 90 minutes, 2.2 percent died, compared to 5.7 percent of those who received PCI after the 90-minute window. However, researchers note that they need a larger sample size to prove definitively that the coordinated system results in improved survival.
Transporting STEMI Patients to PCI Center, Even When Farther Away, May Reduce Deaths
Taking STEMI patients directly to a PCI-capable hospital rather than to a non-PCI hospital—even if it’s closer—reduces the time to treatment and may improve survival, new research suggests.
As part of North Carolina’s coordinated system to treat STEMI [known as RACE-ER; see above], Duke researchers examined EMS records on more than 1,200 STEMI patients between June 2008 and September 2010. Researchers then consulted Google maps to see if patients were taken to the nearest hospital, or if EMS bypassed the local hospital and took patients to a PCI center. Of 1,224 patients, 63 percent went directly to a PCI hospital and 37 percent were taken to the nearest non-PCI hospital and later transferred.
Time from first medical contact to PCI averaged 95 minutes for those taken directly to a PCI hospital, compared with 179 minutes for those taken to the local non-PCI hospital. Researchers detected a lower in-hospital mortality rate for patients taken directly to a PCI hospital (6.3 percent vs. 9.4 percent), but the results were not statistically significant after other factors were taken into account, according to the research, which was presented in May at the American Heart Association’s Quality of Care and Outcomes Research 2012 Scientific Sessions.
Teen Drivers Drink Less, Text More
Teens are drinking and driving less and wearing seatbelts more often than they did 20-plus years ago, according to a survey in the June 8 issue of the CDC’s Morbidity and Mortality Weekly Report. The bad news is teens have picked up a new dangerous behavior: texting while driving.
One in three teens had sent a text or e-mail while driving within the prior month, according to data collected from 2010 to 2011 by the Youth Risk Behavior Surveillance System, which surveyed 15,000 high school students nationwide. On the other hand, the number of students who don’t wear seatbelts dropped from 26 percent in 1991 to 8 percent in 2011. The survey also found a 20 percent drop in the number of students who had ridden with a driver who had been drinking (40 percent vs. 24 percent), and a 53 percent decline in the number of students who drove after drinking (17 percent vs. 8 percent) from 1997 to 2011.
Car crashes account for one in three teen deaths, research shows.
Getting Passengers to Use the Elevator at Airport May Reduce Falls Risk
At Boston Logan International Airport, EMS responded to a call involving a fallen traveler every two days in 2009 and 2010, and 44 percent of falls occur near an escalator, according to an analysis from Boston Medical Center Injury Prevention Center. Nine in 10 falls resulted in a documented injury during this timeframe, while nearly four in 10 (37 percent) were transported to the hospital.
To reduce the falls risk, researchers suggest using signs and other audio warnings to encourage at-risk passengers toting cumbersome baggage to use an elevator instead of the escalator. The findings, they add, may also apply to other public places, including transit stations and malls. The study was published online in the Journal of Safety Research in April.
Implantable Defibrillators Reduce Cardiac Arrest from Ventricular Fibrillation
Implantable cardioverter defibrillators (ICDs)—small electronic devices implanted in the chest of people at high risk of sudden cardiac death—reduce death from cardiac arrest due to ventricular fibrillation (VF) by detecting and halting potentially fatal abnormal heart rhythms, a new study shows.
Researchers from the Academic Medical Center in the Netherlands used data from the Amsterdam Resuscitation Studies registry of cardiac responses and resuscitations by EMS in the greater Amsterdam area from 1995 to 1997 and 2005 to 2008. Focusing on people known to have VF when EMS arrived, researchers found:
- An estimated 339 shocks successfully stopped 194 instances of abnormal heart rhythms in 166 people.
- The percentage of patients with VF cardiac arrest fell from 63 percent between 1995 and 1997 to 47 percent between 2005 and 2008.
- The annual incidence of VF cardiac arrests fell significantly, from 21.1 people per 100,000 to 17.4 per 100,000.
- In greater Amsterdam, ICDs prevented an estimated 81 cardiac arrests between 2005 and 2008.
The study was published Aug. 6 in Circulation.
