Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming
BackgroundPrimary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients presenting with ST‐segment elevation myocardial infarction; however, to be effective, PCI must be performed in a timely manner. Rural regions are at a severe disadvantage, given the relative...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2016-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.003392 |
| _version_ | 1811275114714497024 |
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| author | James R. Langabeer Derek T. Smith Marylou Cardenas‐Turanzas Benjamin L. Leonard Wendy Segrest Chris Krell Theophilus Owan Michael D. Eisenhauer Daniela Gerard |
| author_facet | James R. Langabeer Derek T. Smith Marylou Cardenas‐Turanzas Benjamin L. Leonard Wendy Segrest Chris Krell Theophilus Owan Michael D. Eisenhauer Daniela Gerard |
| author_sort | James R. Langabeer |
| collection | DOAJ |
| description | BackgroundPrimary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients presenting with ST‐segment elevation myocardial infarction; however, to be effective, PCI must be performed in a timely manner. Rural regions are at a severe disadvantage, given the relatively sparse number of PCI hospitals and long transport times. Methods and ResultsWe developed a standardized treatment and transfer protocol for ST‐segment elevation myocardial infarction in the rural state of Wyoming. The study design compared the time‐to‐treatment outcomes during the pre‐ and postintervention periods. Details of the program, changes in reperfusion strategies over time, and outcome improvements in treatment times were reported. From January 1, 2013, to December 31, 2014, 889 patients were treated in 11 PCI‐capable hospitals (4 in Wyoming, 7 in adjoining states). Given the large geographic distance in the state (median of 47 miles between patient and PCI center), 52% of all patients were transfers, and 36% were administered fibrinolysis at the referral facility. Following the intervention, there was a significant shift toward greater use of primary PCI as the dominant reperfusion strategy (from 47% to 60%, P=0.002), and the median total ischemic time from symptom onset to arterial reperfusion was decreased by 92 minutes (P<0.001). There was a similar significant reduction in median time from receiving center door to balloon of 11 minutes less than the baseline time (P<0.01). ConclusionsRural systems of care for ST‐segment elevation myocardial infarction require increased levels of cooperation between emergency medical services agencies and hospitals. This study confirms that total ischemic times can be reduced through a coordinated rural statewide initiative. |
| first_indexed | 2024-04-12T23:32:19Z |
| format | Article |
| id | doaj.art-1668f1a3c6074f37a4ebeb9250dfd769 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T23:32:19Z |
| publishDate | 2016-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-1668f1a3c6074f37a4ebeb9250dfd7692022-12-22T03:12:14ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-05-015510.1161/JAHA.116.003392Impact of a Rural Regional Myocardial Infarction System of Care in WyomingJames R. Langabeer0Derek T. Smith1Marylou Cardenas‐Turanzas2Benjamin L. Leonard3Wendy Segrest4Chris Krell5Theophilus Owan6Michael D. Eisenhauer7Daniela Gerard8University of Texas Health Science Center, Houston, TXUniversity of Wyoming, Laramie, WYUniversity of Texas Health Science Center, Houston, TXAmerican Heart Association, Denver, COAmerican Heart Association, Denver, COSouth Lincoln Medical Center, Kemmerer, WYUniversity of Utah, Salt Lake City, UTPrivate Practice, Casper, WYCampbell County Memorial Hospital, Gillette, WYBackgroundPrimary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients presenting with ST‐segment elevation myocardial infarction; however, to be effective, PCI must be performed in a timely manner. Rural regions are at a severe disadvantage, given the relatively sparse number of PCI hospitals and long transport times. Methods and ResultsWe developed a standardized treatment and transfer protocol for ST‐segment elevation myocardial infarction in the rural state of Wyoming. The study design compared the time‐to‐treatment outcomes during the pre‐ and postintervention periods. Details of the program, changes in reperfusion strategies over time, and outcome improvements in treatment times were reported. From January 1, 2013, to December 31, 2014, 889 patients were treated in 11 PCI‐capable hospitals (4 in Wyoming, 7 in adjoining states). Given the large geographic distance in the state (median of 47 miles between patient and PCI center), 52% of all patients were transfers, and 36% were administered fibrinolysis at the referral facility. Following the intervention, there was a significant shift toward greater use of primary PCI as the dominant reperfusion strategy (from 47% to 60%, P=0.002), and the median total ischemic time from symptom onset to arterial reperfusion was decreased by 92 minutes (P<0.001). There was a similar significant reduction in median time from receiving center door to balloon of 11 minutes less than the baseline time (P<0.01). ConclusionsRural systems of care for ST‐segment elevation myocardial infarction require increased levels of cooperation between emergency medical services agencies and hospitals. This study confirms that total ischemic times can be reduced through a coordinated rural statewide initiative.https://www.ahajournals.org/doi/10.1161/JAHA.116.003392outcomes researchprimary percutaneous coronary interventionquality of careST‐segment elevation myocardial infarctionsystems of care |
| spellingShingle | James R. Langabeer Derek T. Smith Marylou Cardenas‐Turanzas Benjamin L. Leonard Wendy Segrest Chris Krell Theophilus Owan Michael D. Eisenhauer Daniela Gerard Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease outcomes research primary percutaneous coronary intervention quality of care ST‐segment elevation myocardial infarction systems of care |
| title | Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming |
| title_full | Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming |
| title_fullStr | Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming |
| title_full_unstemmed | Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming |
| title_short | Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming |
| title_sort | impact of a rural regional myocardial infarction system of care in wyoming |
| topic | outcomes research primary percutaneous coronary intervention quality of care ST‐segment elevation myocardial infarction systems of care |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.003392 |
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