1. The Effect of Implementation of the American Heart Association Mission Lifeline PreAct Algorithm for Prehospital Cardiac Catheterization Laboratory Activation on the Rate of 'False Positive' Activations
- Author
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Nathan McNeil, William J. French, Gregory S. Thomas, Marianne Gausche-Hill, Michael R. Gunderson, Eric C Nakkim, Timothy D. Henry, Amy H. Kaji, Roger J. Lewis, Kevin Andruss, Nichole Bosson, and Juliana Tolles
- Subjects
Male ,Emergency Medical Services ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Emergency Nursing ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Clinical Protocols ,Outcome Assessment, Health Care ,medicine ,Humans ,False Positive Reactions ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Cardiac catheterization ,Aged, 80 and over ,business.industry ,Percutaneous coronary intervention ,American Heart Association ,Odds ratio ,Emergency department ,Middle Aged ,medicine.disease ,United States ,Conventional PCI ,Emergency Medicine ,Number needed to treat ,ST Elevation Myocardial Infarction ,Female ,Laboratories ,business ,Algorithm ,Algorithms ,Prehospital Emergency Care - Abstract
Hypothesis:Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation.Methods:This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B.Results:A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B.Conclusions:The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.
- Published
- 2020