Partners in Innovation | In the event of a heart attack, time immediately starts working against you. For those unlucky enough to endure a ST-elevation myocardial infarction (STEMI) — wherein the complete closure of a major coronary artery occurs — this diminishing window of one’s survival is particularly short. The deadliest form of heart attack, STEMI requires immediate reperfusion therapy, either through primary percutaneous coronary intervention (PCI) or the use of thrombolytic drugs. Performing the former therapy within 90 minutes of medical contact has been long regarded as the optimal threshold for successfully saving someone’s life.

Sadly just up to 30 percent of patients in the U.S. suffering from STEMI never receive either treatment. Of those that manage to receive primary PCI, only 40 percent do so within the recommended 90-minute timeframe.

In an effort to provide a more comprehensive system of care within its various regions, one that will hopefully counter these alarming medical statistics — the Louisiana Emergency Response Network (LERN), in conjunction with engaged cardiologists nominated by the Louisiana Chapter of the ACC, have undertaken efforts to create a state-wide system of care for this time-critical illness.

The latest in a growing trend of state-based agencies addressing STEMI treatment — including North Carolina’s Reperfusion of Acute Myocardial Infarction in Carolina’s Emergency Departments (RACE) and Missouri’s Time Critical Diagnosis (TCD) System — LERN was created by the Louisiana legislature in 2004 and charged with developing and maintaining a statewide system of care coordination for patients stricken by serious traumatic or time-sensitive illness.

The initiative is an effort to align national performance goals with local and regional resources, to optimize care of patients. To date, LERN’s data show the gap in care under current systems of care, and have helped us identify the areas of greatest need in system-improvement. While we are not changing clinical paradigms, we are attempting to implement best practices as established by ACC through the Door-to-Balloon Alliance and the American Heart Association through Mission: Lifeline.

With funding for operations established in 2006, LERN has organized itself into nine regional commissions, populated with stakeholder volunteers that live and work within the area they represent. Working with local hospital providers, measures are being introduced to conceive of appropriate triage and clinical pathways and encourage data-sharing through participation in data collection and review. Most importantly, the initiative is identifying which hospitals are capable of angioplasty at all times and which don’t have such protocols in place. With these sites properly located, new strategies can be put in place depending on where an incoming STEMI patient is originating.

Because heart tissue dies with every minute, every minute matters and the treatment and strategy — depending on whether it is clot busting drugs or balloons and stents — needs to be provided in a very short time period. Our efforts through LERN and the STEMI Initiative are to identify the hospitals that are best able to provide this care, identify the areas of the state that are covered and are an appropriate geographic distant from these hospitals, and get patients to the right place they need for the right care at the right time.

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Article written by Murtuza Ali, MD, FACC, who is the STEMI medical director for the Louisiana Emergency Response Network, and associate professor of clinical medicine at LSU School of Medicine in New Orleans.

Keywords: Myocardial Infarction, Louisiana, Angioplasty, Critical Pathways, Stents, Percutaneous Coronary Intervention, Triage, Cardiology Magazine, ACC Publications

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