An electrocardiogram (ECG) is an important, non-invasive diagnostic test which measures the electrical activity of the heart. A normal ECG produces a predictable sequence of waves that correspond with each heartbeat. An ECG is used in the diagnosis of arrhythmias and other diseases of the heart and is pivotal in the diagnosis of a heart attack. The American college of Cardiology labels it as the most important initial test for diagnosing myocardial ischemia¹.

Evidence suggests that delay in ECG administration leads to poor clinical outcomes². The current American Heart Association guidelines suggest an ECG be administered no longer than 5 minutes after the patient comes into contact with a medical professional when an MI is suspected. This ensures rapid diagnosis and subsequent treatment if necessary¹.

Neither the national nor Arkansas average time from contact to ECG meet this 5 minute benchmark. Arkansas showed an increase from 7 to 8 minutes in 2017 and 2018, respectively. Nationally, there has been a trend towards the benchmark with 5.7 and 5.6 minutes in 2017 and 2018, respectively. 

Source: ¹ Wagner, G. S., Macfarlane, P., Wellens, H., Josephson, M., Gorgels, A., Mirvis, D. M., . . . Gettes, L. S. (2009). AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram. Journal of the American College of Cardiology,53(11), 1003-1011. doi:10.1016/j.jacc.2008.12.016

Source: ² Diercks, D. B., Kirk, J. D., Lindsell, C. J., Pollack, C. V., Hoekstra, J. W., Gibler, W. B., & Hollander, J. E. (2006). Door-to-ECG time in patients with chest pain presenting to the ED. The American Journal of Emergency Medicine,24(1), 1-7. doi:10.1016/j.ajem.2005.05.016

The following groups and organizations have been pivotal in the efforts to improve STEMI outcomes:
• American College of Cardiology 
• Arkansas Department of Health Tobacco Cessation and Prevention Branch 
• Arkansas Department of Health Trauma Branch – Stroke and STEMI Section 
• Arkansas Department of Health Chronic Disease Branch 
• Heart Disease and Stroke Prevention Coalition 
• STEMI Advisory Council

The evidence clearly suggests that rapid treatment of a myocardial infarction is imperative in ensuring the best patient outcome. The first step in treatment is identification and diagnosis of the problem, which is most easily confirmed with an ECG¹.  It has been shown that delay in the ECG administration can negatively affect patient outcomes. This study particularly found increased risk of adverse clinical outcomes that were found 30 days after STEMI².

Source: ¹ Wagner, G. S., Macfarlane, P., Wellens, H., Josephson, M., Gorgels, A., Mirvis, D. M., . . . Gettes, L. S. (2009). AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram. Journal of the American College of Cardiology,53(11), 1003-1011. doi:10.1016/j.jacc.2008.12.016

Source: ² Diercks, D. B., Kirk, J. D., Lindsell, C. J., Pollack, C. V., Hoekstra, J. W., Gibler, W. B., & Hollander, J. E. (2006). Door-to-ECG time in patients with chest pain presenting to the ED. The American Journal of Emergency Medicine,24(1), 1-7. doi:10.1016/j.ajem.2005.05.016

The Arkansas Department of Health is making efforts in order to decrease the mean time that a patient with a suspected MI receives an ECG. The first is providing 12-lead ECG equipment for 6 providers that serve 15 Arkansas counties. This will increase the Emergency Medical Services ability to assess and manage STEMI patients in a timely manner. The ADH has also initiated general efforts that will affect this metric. The first is creating a STEMI best practices operations toolkit to increase adherence to the latest evidence-based treatment guidelines. The second is developing a STEMI pilot program in the northeast Arkansas and southwest Arkansas regions aimed at improving care coordination between EMS and hospitals. The ADH is also providing online STEMI education on evidence-based practices for all physicians, nurses, and pre-hospital providers in the state. This education will include the importance and guidelines associated with ECGs.