Providing regionalized care for heart emergencies would save lives

Each year, the number of deaths in the state due to cardiovascular emergencies approaches 30,000. Although advanced treatments such as angioplasty, “clot-busting” drugs, or whole-body cooling can reduce deaths, there is a short time window in which the treatments work most effectively – and not every hospital is able to provide them. This is why we should create regionalized systems of care for heart attack, cardiac arrest and stroke. By coordinating care across hospitals and encouraging them to work as partners, we could deliver the right resources to the right patient at the right time, saving lives.

Michigan has only recently begun to consider a statewide cardiovascular emergency system, with no stable or dedicated resources by the state currently targeted toward the effort. This is an oversight that needs to be corrected. Last October, Gov. Snyder signed important legislation that ensures ongoing funding for a statewide trauma network for patients suffering major injuries like car accidents. The state should consider funding a similar network for cardiovascular emergencies.

For victims of heart attacks, other states began to establish regionalized systems over a decade ago, borrowing off the successful model of trauma networks. For example, in North Carolina, the Regional Approach to Cardiovascular Emergencies (RACE) project coordinates care across more than 100 hospitals, more than 500 emergency medical agencies, and thousands of health care providers. As a result of RACE, the time required for sending patients between hospitals for angioplasty dropped by nearly half from 120 to 71 minutes in the case of heart attacks. This approach is now being expanded across the country, although not in Michigan. Similar approaches have made significant inroads in Europe and Canada.

To date, the biggest barriers identified toward developing cardiovascular emergency systems center are financial concerns by hospitals, data collection infrastructure and lack of standardized protocols – all aspects of care that could benefit from leadership by state government.

For instance, hospitals are currently reimbursed well for services related to cardiovascular emergencies, which has made smaller hospitals hesitant to participate due to concerns about a loss of patients. However, other states, including North Carolina, have overcome this possible barrier by creating “inclusive” systems that ensure all hospitals – small and big – play an important role.

Designing an inclusive system also builds on natural strengths of Michigan hospitals. We have a long history of statewide collaborative efforts for improving quality across numerous diseases, including the use of angioplasty during heart attacks. This could serve as a foundation for data collection and creation of standardized protocols. Exemplary pockets of this type of work have already begun to show up, including in challenging areas with sparse populations.

For instance, the STEMI Initiative of Northern Lower Michigan has described a local collaboration across multiple hospitals that demonstrated improvements in heart attack care for rural communities. The timing for considering regionalized systems of care for cardiovascular emergencies is imperative, because the state is currently determining how to restructure emergency medical services as part of the trauma network. Not acting could miss a unique chance for change.'

As Michigan advances toward a statewide trauma system to treat broken bodies, it is important not to lose sight of the broken hearts that could benefit from an analogous approach. The lives at stake make this too important an opportunity to slip away.

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