Published: Nov. 16, 2010
Updated: Nov. 17, 2010
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By Duke Medicine News and Communications
A program designed to speed up heart attack care has led to significant improvement in the quality of care for heart attack patients after it was extended across North Carolina last year, according to researchers at Duke University Medical Center.
Speedy treatment leads to less heart damage and saved lives among heart attack patients. The RACE-ER results mark a notable decrease in hospital death rates, from 7.5 percent in the 2006 RACE study to below 6 percent now.
The program, RACE-ER (which stands for reperfusion of acute myocardial infarction in Carolina emergency departments -- emergency response) builds on the successful RACE project.
The initial project involved emergency services personnel, physicians, nurses and administrators working collaboratively to reduce the time between occurrence of heart attack and initial treatment.
RACE-ER expands the program to all 119 hospitals and all emergency medical services systems throughout North Carolina and focuses on early diagnosis, early treatment, and optimizing performance at every point of care.
"This program results in many more patients getting life-saving care quickly," said Christopher Granger, MD, director of the Cardiac Care Unit at the Duke Clinical Research Institute and co-director of RACE.
"Before launching RACE-ER ambulances and community hospitals were not working in integrated regional systems, and patients were suffering with delays in care much longer than recommended in the guidelines. Now, almost all ambulances are obtaining EKGs, patients are being brought directly to the best equipped hospitals, and we are experiencing some of the most rapid treatment in North Carolina that has ever been achieved."
The findings were presented Tuesday at the American Heart Association's Scientific Sessions 2010 in Chicago, Ill.
Guidelines by the American College of Cardiology and the American Heart Association state that patients suffering from heart attacks due to blocked arteries should receive clot-busting medical therapy within 30 minutes or artery-opening therapy within 90 minutes.
The RACE-ER study consisted of 6,841 patients with a specific type of heart attack called STEMI, which can be treated successfully with prompt, artery-opening care or angioplasty.
Each extension of the RACE program has brought added success and a deeper, more collaborative look at providing the best quality of care.
"We have expanded what we know as door-to-balloon (or arrival at hospital to treatment), to really look at the time between the moment the patient accesses the emergency system to when we can offer them treatment," said Mayme Lou Roettig, RN, MSN, executive director of RACE.
With the RACE and RACE-ER projects, once a patient calls 911 the timer starts. Rather than just improving the speed of care once a patient reaches the hospital, the project takes the task outside of the hospital doors to the emergency vehicle.
The result, Roettig said, is multiple, competing health care systems working together with their EMS agencies to provide the highest quality of care for heart attack patients.
"We developed protocols, that paramedics follow when they have a patient with a STEMI, that empower them to make decisions," she said. "They know to bypass a smaller emergency department and take the patient directly to a hospital that offers interventional angioplasty. And, they know to call ahead so that the center is prepared when they arrive."
The results show a substantial change in urban areas with more people calling 911 and more patients going directly to specialty centers. There has also been improvement among smaller hospitals, which transfer patients to specialty centers, in reducing their door-in to door-out times.
"We've seen the impact a program like this can have, simply by getting paramedics, emergency medicine, and hospitals to work in an integrated way. The next steps are to help other states achieve the same success, and to use similar regional systems to improve the care of other cardiac emergencies like cardiac arrest," Granger said.
The RACE and RACE-ER project leadership also includes James G. Jollis, MD, the co-medical director of RACE and Lisa Monk, RN, the RACE-ER state project leader.