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In-Hospital STEMIs Make Up 20% of all Cases -- But the Mortality Rate is 10x Higher for Those Patients

Picture of Hannah Ostrem Hannah Ostrem : Aug 21, 2019

In-Hospital STEMIs Make Up 20% of all Cases -- But the Mortality Rate is 10x Higher for Those Patients
According to a report from the American Heart Association, the annual incidence rate for STEMI is 550,000 new cases in the United states, and 200,000 recurrent. Of those, total 750,000 incidents, around 20% occur in in-hospital patients.
 
Unfortunately, according to an article published in JAMA Cardiology, "Mortality rates are 10-fold higher than for out-of-hospital STEMI and can approach mortality rates associated with cardiogenic shock."
 
Why are these rates so much higher for in-hospital versus out-of-hospital patients? Researchers identify three main areas of delay in treating in-hospital STEMI, which may contribute to poorer outcomes:
 
1. Delay in ECG acquisition
2. Delay in ECG interpretation
3. Delay in activation of STEMI teams
 
What can be done to reduce the delay in treatment for in-hospital STEMI patients? First, hospital teams need a lower threshold for performing an ECG in patients exhibiting first signs of myocardial infarction. Second, hospitals need a process for QUICKLY getting the ECG into the hands of the cardiologist for immediate interpretation. And finally, a reliable, effective, consistent system for activating the STEMI system of care is essential. 
 
Technologies like pagers and fax machines were never an effective match for managing complex conditions like STEMI, particularly when in-hospital patients present different challenges than those whose conditions originate outside the hospital. The health systems that will be most successful in meeting those challenges will be those who have a consistent system that reduces variance in the treatment process, and works regardless of method of arrival. As the ACC points out, "The process of STEMI team or catheterization laboratory activation for an in-hospital STEMI should as much as possible mirror that for patients who present to the emergency department and are diagnosed as having STEMI."
 
Mobile technology offers a solution to these obstacles -- ECG findings can be instantly transmitted to individuals or entire dynamic teams, and activation of those teams can now be done with a single tap of a button on care coordination app platforms like Pulsara. 
 
How does your team ensure you have a consistent process for in-hospital STEMI patients? We want to hear from you. 
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