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.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Frendl, DM; Palmeri, ST; Clapp, JR; Hampton, D; Sejersten, M; Young, D; Drew, B; Farrell, R; Innes, J; Russell, J; Rowlandson, GI; Purim-Shem-Tov, Y; Underhill, BK; Zhou, S; Wagner, GS; Journal of Electrocardiology Prehospital 12-lead ECG Working Group,

Published Date

  • 2009

Published In

Volume / Issue

  • 42 / 5

Start / End Page

  • 426 - 431

PubMed ID

  • 19446840

Electronic International Standard Serial Number (EISSN)

  • 1532-8430

Digital Object Identifier (DOI)

  • 10.1016/j.jelectrocard.2009.03.011


  • eng

Conference Location

  • United States