Abstract 120: Assessing the Impact of a Rural STEMI System of Care Initiative: Mission: Lifeline Wyoming

Introduction: Regional systems of care for ST-elevation myocardial infarction (STEMI), such as in Minnesota and North Carolina, have demonstrated improvements in quality of care outcomes. The objective in this study was to collect baseline data on Wyoming statewide STEMI incidence and assess changes in ischemic times and mortality following deployment of a statewide, system of care initiative in the rural state of Wyoming. Methods: American Heart Association organized a STEMI initiative in 2012 in Wyoming to address the needs for enhanced rural cardiovascular care. Participating were all 10 STEMI-receiving centers in and around the state, 25 acute care/critical access hospitals, Wyoming Department of Health, 56 emergency medical service (EMS) agencies, and hundreds of volunteer multidisciplinary stakeholders. The initiative deployed approximately 30 training programs, placed 165 12-lead electrocardiogram (ECG) devices in ambulance service, and developed dozens of protocols concerning transfers, treatment, and transport for Wyoming and surrounding border-states. The study design was pre-posttest design, using observational methods of de-identified myocardial infarction data extracted from all 10 participating percutaneous coronary intervention (PCI) facilities’ National Cardiovascular Data Registry (NCDR) submissions. There were 2,301 total MI’s, and 889 STEMIs during calendar years 2013-2014 (24 months). We established the first two quarters as our baseline period, and compared differences in median values using Kruskal-Wallis (KW) and chi-square analyses of variances relative to the the subsequent 6 quarters across several outcome measures (total ischemic time, mortality, thrombolytic administration rates). Results: Wyoming has an extremely high transfer rates into PCI, over twice the national average (62%). These transfers produced a long total ischemic time of 291 minutes (nearly 5 hours) in the baseline period, with door-in-door-out times consuming nearly 120 minutes, median. There was a statistically significant 51 minute median reduction in total ischemic times following the program (291 in baseline quarters vs. 241 minutes in subsequent post-intervention periods; KW χ2=4.327, p<.05). There was simultaneously a significant increase in the percent of patients undergoing primary PCI (pPCI) from 54% to 57% (χ2=7.610, p<.01), coupled with a statistically significant reduction in the rate of thrombolytic administration s (46% in the baseline period vs. 37% in the subsequent periods; χ2=6.359, p<.05). Mortality rates were lower than national benchmarks, averaging 3.9% for all MI (5.3% for STEMI), but there were no statistical changes in mortality rates over time. Conclusions Mission: Lifeline Wyoming demonstrated statistically significant reductions in median total ischemic time and higher primary PCI reperfusion rates.