The American Heart Association's guidelines direct care from first contact with patient in the hospital, to the subsequent inpatient treatment of patients experiencing a myocardial infarction. Each one of these steps and treatment guidelines are imperative to a positive patient outcome. This metric provides an effective means of determining how many patients are recieving all the recommended treatments and interventions. This care is deemed "defect free" and is demonstrative of overall patient care. 

The eleven interventions that are included in the defect free designation are:

1. Aspirin on arrival

2. Aspirin prescribed at discharge

3. Beta-Blocker prescribed at discharge

4. Statin prescribed at discharge

5. Evaluation of left ventricular systolic function

6. Ace Inhibitor or Angiotensin Receptor Blocker for left ventricular systolic dysfuntion at discharge

7. Time to fribrinolytic therapy

8. Time to primary PCI

9. Reperfusion therapy

10. Adult smoking cessation advice

11. Cardiac rehabilitation patient referall from an inpatient setting       

The AHA recommends that 100% compliance with the above perfomance measures. However, the national average percentage for patients recieing all of the 11 recommended treatmetns for 2017 and 2018 was 81.3% and 82.3%, repsectively. The Arkansas percentages for the same time frame were found to be lower at 66.0% and 68.2%. Both the national and Arkansas percentages are increasing, and hopefully will continue to  trend to the recommended 100%.   

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 American Heart Association's guidelines are evidence-based and establish the benchmark for effective treatment of ST elevated myocardial infarctions (STEMI).  Each individual guideline has been shown to improve current and future well-being of STEMI patients. Their implementation together, as demonstrated in percent defect free care has also been shown to improve outcomes in STEMI patients. 

The ADH has implemented several quality improvement efforts that may contribute to increasing the percentage of defect free care.  Firstly, the establishment of the Arkansas Heart Attack Registry will aid in the monitoring of the metrics in order to identify the problems at hand. The ADH and Arkansas Heart Attack Registry have also implemented multiple quality improvement initiatives that will contribute to improve defect free care for STEMI patients. These include:

(a) launching the Arkansas Heart Attack Registry which has resulted in the participation of 26 Percutaneous Coronary Intervention (PCI) capable hospitals in the program

(b) providing 12-lead EKG equipment for 6 providers serving 15 Arkansas counties to increase EMS capacity in assessing and managing STEMI patients

(c) creating a STEMI best practices operations toolkit to increase adherence to the latest evidence-based treatment guidelines

(d) developing a STEMI pilot program in the northeast and southwest regions aimed at improving care coordination between EMS and hospitals

(e) providing online STEMI education on evidence-based practice for all physicians, nurses and pre-hospital providers in the state

(f) coordinating a multi-channel community awareness campaign to help Arkansans know the signs and know the importance of dialing 9-1-1 when heart attack is suspected.

The Arkansas Heart Attack Registry is in the planning and early implementation phase. In the future, the ADH STEMI Section plans to conduct hospital site visits to provide technical and quality improvement assistance registry data to help staff identify and close gaps in patient care.