Several poster presentations on rural health delivery and access to care, offering innovative solutions to increase health equity for cardiovascular patients, were featured at ACC Quality Summit 2024.

Among the highlights, new research looking at door-in-door-out and door-to-balloon times for patients presenting to critical access hospitals with myocardial infarction (MI), improving door-to-thrombolytics time for MI patients at rural hospitals, remote cardiac rehabilitation to increase access, and improving communications technology for emergency medical services (EMS) with STEMI patients in rural areas.

Among the abstracts presented:

• Expediting Access to Critical Care Vital For Life-Threatening Cardiac Emergencies in Rural Areas
  PeaceHealth Sacred Heart Medical Center RiverBend in Springfield, OR, set out to reduce door-to-balloon times for patients presenting to their facility with STEMI. By implementing clinical education for emergency department staff and modifying the transfer process to ensure simultaneous STEMI team activation and early LifeFlight Network Air Medical Transport activation, the team reduced their average door-to-door-to-balloon time by 33.8 minutes and average transport time to another hospital was reduced by 18.2 minutes over the course of 18 months.
• Critical Access Hospital, Referring Facility Collaborate to Reduce Time to STEMI Care
  Intermountain Health St. Mary's Regional Hospital in Grand Junction, CO, collaborated with one of their referring hospitals to examine, rework and streamline their transfer process with the goal of minimizing delays in door-to-thrombolytic administration times. The average time for thrombolytics started at 79.5 minutes. Six months after implementation of the new protocol, the average decreased to 66.5 minutes and the next six months average 46 minutes. They have now delivered the updated transfer protocol to all their referring facilities.

• Rural Hospital Systems Using Remote Cardiac Rehab Increase Participation, Completion of Program
  Geisinger Health System, a regional health provider throughout rural Pennsylvania, developed a remote cardiac rehabilitation (rehab) program comprised of a multidisciplinary care team, a personalized recovery kit mailed to patients with stretch bands, monitoring equipment, resistance bands and an internet-enabled tablet, and an individualized treatment plan after a comprehensive evaluation of the patient's needs and goals. The remote program increased the system's cardiac rehab capacity fourfold, improved outcomes, and decreased readmissions and emergency department visits since its implementation in June 2021. In addition, remote patients completed 40% more sessions than traditional center-based rehab patients.
• Leveraging Technology in Vast Rural Areas Improves Timely Communication and Emergent Cardiac Care
  By leveraging updated communications technology, Mat-Su Regional Medical Center in Palmer, AK, was able to improve communication, streamline processes, decrease contact-to-balloon times, and improve clinician satisfaction and reduce staff turnover. The site implemented Pulsara, a mobile telehealth communications app, in May 2020 to connect the STEMI team and EMS in place of radio reports to communicate all EMS arrivals. From 2019 to 2023, the facility had a 37% reduction in time from when EMS obtains a STEMI positive electrocardiogram to when the site's Cath Lab and Cardiology Team is activated.

The ACC aims to achieve a culture of equitable cardiovascular care and heart health for all by using advocacy, education and science to acknowledge social determinants of health and eliminate disparities.

"Rurality creates unique challenges in delivering high quality cardiovascular care and eliminating health inequities," said ACC Health Equity Task Force Chair Paul L. Douglass, MD, MACC. "Cardiovascular research in rural communities is creating a framework for strategic implementation of telemedicine, innovation, advocacy, education and remote monitoring that informs a way forward."

Resources

• Member Publications

Clinical Topics: Cardiovascular Care Team

Keywords: Cardiology Magazine, ACC Publications, Quality of Health Care, Quality Summit, Artificial Intelligence, Patient Care Team, Telemedicine, Cardiac Rehabilitation