Overcoming barriers to developing seamless ST-segment elevation myocardial infarction care systems in the United States: recommendations from a comprehensive Prehospital 12-lead Electrocardiogram Working Group

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• 作者：Daniel M. Frendl ; Sebastian T. Palmeri ; J. Robert Clapp Jr. ; David Hampton ; Maria Sejersten ; Dwayne Young ; Barbara Drew ; Robert Farrell ; Jan Innes ; James Russell ; G. Ian Rowl ; son ; Yanina Purim-Shem-Tov ; B. Kevin Underhill ; Sophia Zhou ; Galen S. Wagner ; on behalf of the Journal of Electrocardiology
• 关键词：STEMI ; Emergency medical services ; Electrocardiography ; Emergency department
• 刊名：Journal of Electrocardiology
• 出版年：2009
• 出版时间：September-October 2009
• 年：2009
• 卷：42
• 期：5
• 页码：426-431
• 全文大小：133 K

文摘

Background

Reducing time to reperfusion treatment for patients with ST-segment elevation myocardial infarction (STEMI) improves patient outcomes. Few medical systems consistently meet current benchmarks regarding timely access to treatment. Studies have widely demonstrated that prehospital 12-lead electrocardiography can facilitate early catheterization laboratory activation and is the most effective means of decreasing patients' time to treatment.

Methods

We gathered experts to examine the barriers to implementation of prehospital 12-lead electrocardiographic monitoring and transmission to in-hospital cardiologists in creating seamless STEMI care systems (STEMI-CS) and propose multidisciplinary approaches to overcoming these barriers.

Results and Conclusions

Physicians, hospital systems, and emergency medical services often lack coordination of care delivery and receive fragmented funding and oversight. Clinical and regulatory guidelines do not emphasize local solutions to achieving clinical benchmarks, do not target incentives at all components of the STEMI-CS, and underemphasize risk-based approaches to protecting patient health. Integration of the multiple complex components involved in STEMI-CS is essential to improving care delivery.