title: Developing an ST-elevation myocardial infarction system of care in Dallas County.
abstract: BACKGROUND
  The American Heart Association Caruth Initiative (AHACI) is a multiyear project to increase the speed of coronary reperfusion and create an integrated system of care for patients with ST-elevation myocardial infarction (STEMI) in Dallas County, TX. The purpose of this study was to determine if the AHACI improved key performance metrics, that is, door-to-balloon (D2B) and symptom-onset-to-balloon times, for nontransfer patients with STEMI.
  
  
  METHODS
  Hospital patient data were obtained through the National Cardiovascular Data Registry Action Registry-Get With The Guidelines, and prehospital data came from emergency medical services (EMS) agencies through their electronic Patient Care Record systems. Initial D2B and symptom-onset-to-balloon times for nontransfer primary percutaneous coronary intervention (PCI) STEMI care were explored using descriptive statistics, generalized linear models, and logistic regression.
  
  
  RESULTS
  Data were collected by 15 PCI-capable Dallas hospitals and 24 EMS agencies. In the first 18 months, there were 3,853 cases of myocardial infarction, of which 926 (24%) were nontransfer patients with STEMI undergoing primary PCI. D2B time decreased significantly (P < .001), from a median time of 74 to 64 minutes. Symptom-onset-to-balloon time decreased significantly (P < .001), from a median time of 195 to 162 minutes.
  
  
  CONCLUSIONS
  The AHACI has improved the system of STEMI care for one of the largest counties in the United States, and it demonstrates the benefits of integrating EMS and hospital data, implementing standardized training and protocols, and providing benchmarking data to hospitals and EMS agencies.
authors.affiliation: University of Texas School of Public Health, Houston, TX 77030, USA. jami.l.dellifraine@uth.tmc.edu
authors.forename: Jami
authors.initials: J
authors.lastname: DelliFraine
authors.forename: James
authors.initials: J
authors.lastname: Langabeer
authors.forename: Wendy
authors.initials: W
authors.lastname: Segrest
authors.forename: Raymond
authors.initials: R
authors.lastname: Fowler
authors.forename: Richard
authors.initials: R
authors.lastname: King
authors.forename: Peter
authors.initials: P
authors.lastname: Moyer
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
authors.forename: William
authors.initials: W
authors.lastname: Koenig
authors.forename: John
authors.initials: J
authors.lastname: Warner
authors.forename: Leilani
authors.initials: L
authors.lastname: Stuart
authors.forename: Russell
authors.initials: R
authors.lastname: Griffin
authors.forename: Safa
authors.initials: S
authors.lastname: Fathiamini
authors.forename: Jamie
authors.initials: J
authors.lastname: Emert
authors.forename: Mayme Lou
authors.initials: ML
authors.lastname: Roettig
authors.forename: James
authors.initials: J
authors.lastname: Jollis
mesh_terms: D000572:American Heart Association; D019033:Delivery of Health Care, Integrated / Q000592:standards / Q000639:trends*; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000639:trends*; D016730:Program Development; D012042:Registries; D012189:Retrospective Studies; D013781:Texas; D013997:Time Factors; D014481:United States