Recommendations for the Early Management of Adults with ST-Elevation Myocardial Infarction
Recommendations for the Early Management of Adults with ST-Elevation Myocardial Infarction (PDF, 11 MB)
In 2003, Assembly Bill 1220 established the California Heart Disease and Stroke Prevention and Treatment Task Force (Master Plan Task Force) and charged it with writing California’s Master Plan for Heart Disease and Stroke Prevention and Treatment (Master Plan). This effort was a public health priority, since heart disease and stroke are, respectively, the first and third leading causes of death in California. The Master Plan was adopted by the California Department of Health Services (now the California Department of Public Health) in 2007.
One of the topics the Master Plan addresses is the care of a particular type of heart attack called ST-elevation myocardial infarction (STEMI). This term refers to the specific pattern that is observed on an electrocardiogram (ECG). Approximately 30 percent of heart attacks in the United States are classified as STEMIs. Less acute forms of blood vessel blockage in the heart include non-STEMIs and unstable angina. The Master Plan proposes a STEMI system of care that encourages identification of eligible patients in the field and direct transport to hospitals that provide the most appropriate acute care. It envisions the creation of STEMI-Receiving Centers (SRCs), hospitals that provide optimal STEMI care. The Master Plan stresses the importance of building a system that is fully inclusive, thereby avoiding service gaps. The STEMI system of care concept is consistent with the position statements of the American Heart Association/American Stroke Association (AHA/ASA) and other expert groups, as well as with the vision being realized by other states across the nation.
The Master Plan Task Force recognized the many technical and policy issues inherent in the development of a STEMI system of care and recommended the establishment of a STEMI Systems Work Group. In 2007, the STEMI Work Group was co-convened by the California Heart Disease and Stroke Prevention (CHDSP) Program of the California Department of Public Health and the AHA/ASA to implement the STEMI recommendations of California’s Master Plan for Heart Disease and Stroke Prevention and Treatment. The American College of Cardiology (ACC), California Chapter, which has been central to efforts to improve STEMI care in the state, joined AHA/ASA and the CHDSP Program as a co-sponsor of this project.
The STEMI Work Group is a multidisciplinary group that includes experts in emergency medical services, emergency medicine, cardiology, specialty nursing (cardiology and emergency), hospital administration, and rural health care. The Work Group includes representation from the major public and private organizations that promote quality STEMI care, including: the ACC, California Chapter; the California Hospital Association; California Chapter, American College of Emergency Physicians (CAL/ACEP); California Emergency Medical Services Authority (EMS Authority); Emergency Medical Services Administrators Association of California (EMSAAC); Emergency Medical Services Medical Directors Association of California (EMDAC); and city and county departments of public health. The STEMI Work Group met in person and electronically throughout their work period.
The outcome from the deliberations of the STEMI Work Group is this document, The Recommendations for the Early Management of Adults with ST-Elevation Myocardial Infarction: A Statewide Plan for California (Recommendations). The Recommendations were informed by the experiences of the local emergency medical services agencies (LEMSAs) that have already implemented STEMI systems in their jurisdictions. Every effort was made to use the systems that have been established as a foundation for the future. The intent of this document is to describe a system of care that promotes the safe use of effective therapies for STEMI, assuring that every Californian will receive the highest level of STEMI care. These Recommendations are consistent with position statements around optimal patient care offered by STEMI care advocates, including 2004 ACC/AHA STEMI guidelines, the 2007 and 2009 ACC/AHA focused STEMI guideline updates, and the 2008 European Society of Cardiology STEMI guidelines.