Systems of Care for STEMI: AHA Policy Statement

Jacobs AK, Ali MJ, Best PJ, et al., on behalf of the American Heart Association Advocacy Coordinating Committee.
Systems of Care for ST-Segment–Elevation Myocardial Infarction: A Policy Statement From the American Heart Association. Circulation 2021;Oct 13:[Epub ahead of print].

The following are key points to remember about a policy statement from the American Heart Association (AHA) on systems of care for ST-segment–elevation myocardial infarction (STEMI):

  1. The introduction of Mission: Lifeline significantly increased timely access to percutaneous coronary intervention (PCI) for patients with STEMI. In the years since, morbidity and mortality rates have declined, and research has led to significant developments that have broadened our concept of the STEMI system of care. However, significant barriers and opportunities remain.
  2. This policy statement sets forth recommendations for how the ideal STEMI system of care should be designed and implemented to ensure that patients with STEMI receive the best evidence-based care at each stage in their illness.
  3. Increase public awareness campaigns of heart attack signs and symptoms and the importance of calling 9-1-1; pursue individualized interventions, especially for those at increased risk (patients with prior acute coronary syndromes or known coronary artery disease).
  4. Adopt and implement prehospital cardiac catheterization laboratory (CCL) activation and direct to catheterization laboratory protocols when appropriate for STEMI receiving centers.
  5. STEMI referring hospitals should have a planned reperfusion strategy in place (either fibrinolytic administration or transfer for PCI).
  6. STEMI referring hospitals and STEMI receiving centers should have preplanned agreements in place including: a) one-call transfer process, b) automatic acceptance, c) treatment algorithms, and d) transfer processes (primary and backup).
  7. The CCL should be activated as early as possible before arrival of the patient with STEMI at the hospital in order to provide definitive revascularization with the greatest efficiency, especially for high-risk patients.
  8. If the CCL is ready to receive the patient, the emergency department should be bypassed, and direct transport to the CCL should occur for most patients.
  9. Health care systems and practices should implement evidence-based strategies that optimize patient outcomes associated with cardiac rehabilitation referral, early enrollment, and adherence. These strategies should include accountability and quality improvement activities (e.g., performance).
  10. Finally, there should be support for the global reimbursement of the system of care for the patients with STEMI with recognition of each of the components, including referring hospital, receiving center, emergency medical services transport and transfer, and ancillary services.

Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Vascular Medicine, Chronic Angina

Keywords: Acute Coronary Syndrome, Cardiac Catheterization, Cardiac Rehabilitation, Coronary Artery Disease, Delivery of Health Care, Emergency Medical Services, Evidence-Based Medicine, Fibrinolytic Agents, Myocardial Infarction, Percutaneous Coronary Intervention, Quality Improvement, Reperfusion, Secondary Prevention, ST Elevation Myocardial Infarction, Thrombolytic Therapy

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