DURHAM, N.C. — A consortium of North Carolina health care providers and Blue Cross and Blue Shield of North Carolina (BCBSNC) today announced details of a collaborative project to improve the survival rate of patients rushed to the hospital with heart attacks. The consortium, which includes physicians, hospitals and emergency medical services professionals, is launching a new effort called Reperfusion of Acute MI in Carolina Emergency departments (RACE).
"RACE is the most extensive effort in the nation to improve care of heart attack patients by organizing ambulances, emergency departments and hospitals to provide the best treatments," said Duke University Medical Center cardiologist and RACE co-medical director Christopher Granger, M.D. "In North Carolina, it gives us the opportunity to do a much better job treating heart attacks to improve survival."
The issue is especially important in North Carolina, team members said, since national registries have shown that only about 60 percent of North Carolinians who come to an emergency room receive potentially life-saving reperfusion therapies for a myocardial infarction (MI), or heart attack, compared to the national average of at least 70 percent. The RACE project could also serve as a national model for collaborative efforts to improve the delivery of emergency care.
The North Carolina consortium comprises five regions centered in Greenville, Chapel Hill/Durham, Greensboro/Winston-Salem, Charlotte and Asheville. Each region consists of networks of emergency medicine ambulance systems, smaller hospitals and referral hospitals. Other partners in the project include the Duke Clinical Research Institute of Duke University Medical Center and the North Carolina chapter of the American College of Cardiology.
"This project will help save lives in North Carolina," said Robert Harris, M.D., senior vice president of health care services and chief medical officer for BCBSNC, which is supporting the effort with a $1 million corporate grant. "What we are facing in North Carolina is a microcosm of what is happening in the country as a whole - we know that world-class medical services and treatments are available, yet we seem to have a problem with timely access and coordination."
"Unlike some national efforts that attempt to deal with this issue from afar, we are actually in the trenches trying figure out what works the best," said Duke cardiologist and RACE co-medical director James Jollis, M.D. "Much time has been spent over the years conducting clinical trials to figure out what works for heart attack patients. Now, we are trying to put into practice what we all know - that opening arteries quickly saves lives. We have hit a wall at treating about 60 percent of eligible patients and we're not improving much more - we believe we can do better."
Throughout the course of the two-year project, RACE researchers will collect data on heart attack patients - both those who received treatment and those who would have been candidates for reperfusion therapy, but did not receive it. RACE's goal is to provide each facility with feedback to aid streamlining patient evaluation and treatment.
Reperfusion therapies involve using either a clot-busting drug or a catheter, in an operation called an angioplasty. The angioplasty unblocks clogged coronary arteries, sparing heart muscle from damage due to lack of oxygen. While clot-busting, or thrombolytic, drugs are available at most hospitals and emergency rooms, angioplasty is not as widely available. Angioplasty has been found to be more effective than thrombolytics in reopening arteries when performed within 90 minutes of a patient's arrival to the hospital.
RACE plans to improve outcomes of heart attack patients by funding educational nursing programs, conducting physician teleconferencing seminars on reperfusion therapies, providing emergency room guideline tools and expanding the use of electrocardiogram (EKG) machines in ambulances, so vital data about patients' hearts can be transmitted ahead to emergency personnel.
The program will also analyze health care delivery systems at participating hospitals. While many larger centers have layers of service and personnel that provide round-the-clock care, some smaller hospitals do not treat many heart patients and may not be optimally staffed for emergencies, team members said. The program has established a 24-hour hotline administered by senior cardiologists who can consult with emergency room physicians at smaller hospitals lacking an on-site cardiologist available 24 hours a day.
About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.3 million members, including approximately 638,000 served on behalf of other Blue Plans. For 72 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at bcbsnc.com.