The Journal of the Arkansas Medical Society Med Journal Feb 2019 Final 2 | Page 12

EDITORIAL PANEL: Chad T. Rodgers, MD, FAAP | Elena M. Davis, MD, MPH | William L. Mason, MD | Michael Moody, MD | J. Gary Wheeler, MD, MPS
Reducing Heart Attack Deaths in Arkansas
VICKI MEYER, BSN, RN, C4
A
rkansas has the highest acute
myocardial infarction (AMI)
mortality rate in the nation,
according to the Centers
for Disease Control and Prevention
(CDC). Arkansas’ 2016 age-adjusted
AMI mortality rate is 80.2 deaths per
100,000 people, which is 64 percent
higher than the national average of
29.1 deaths per 100,000 people.
Arkansas is attacking this prob-
lem with a two-pronged approach
targeting both the public and medical
professionals. For the public, educa-
tion is key to reducing AMI mortality
rates. Medical professionals must
adopt evidence-based guidelines
and best practices to educate their
patients about preventive health
care and provide resources for better
patient outcomes.
The Arkansas Behavioral Risk
Factor Surveillance System (BRFSS)
shows the state has between the
second- and fifth-highest rate of risk
factors in the nation that increase the
probability of coronary artery disease
and heart attack. These include:
• Smoking
• Diabetes
• High cholesterol
• Adult obesity
• Physical inactivity
• High blood pressure
• Low fruit and vegetable
consumption
Heart attack prevention education
should promote healthy lifestyle
behaviors, recognition of heart attack
signs and usage of 9-1-1 during a
medical emergency, as every minute
matters. Early recognition and treat-
ment of an AMI increases the patient’s
chances for survival.
In September, the Arkansas
Department of Health (ADH) acquired
the Chest Pain-MI Registry dashboard
through the National Cardiology
Data Registry (NCDR). The registry
is a risk-adjusted, outcomes-based
quality improvement program
focusing exclusively on high-risk
ST-Elevated Myocardial Infarction
(STEMI)/Non-STEMI (NSTEMI) patients.
The registry helps hospitals adhere to
the American College of Cardiology’s
clinical guideline recommendations.
The program provides valuable tools
to measure care, achieve quality
improvement goals, improve patient
outcomes and lower health care costs.
In Arkansas, the NCDR Chest
Pain-MI Registry is called the Arkansas
Heart Attack Registry (AHAR). AHAR
is the ADH’s surveillance and quality
improvement program for acute coro-
nary syndrome. AHAR requests that all
STEMI and NSTEMI cases be entered
in the registry. These data will allow
the ADH team to provide surveillance,
monitor care performance, and offer
education and quality improvement
180 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
technical assistance to hospital teams
to improve heart attack patients’ care
and outcomes.
The ADH has successfully recruited
23 of the 26 Arkansas primary cor-
onary interventional (PCI) hospitals
(receiving hospitals) and other PCI
hospitals across the state’s border, to
join a collaborative effort focused on
reducing the impact of heart attacks.
The goal of high-quality STEMI
treatment is to achieve first medical
contact with the patient to balloon
within 90 minutes. Meeting this
evidence-based, national guideline
improves patient outcomes. It is vital
that emergency medical services
(EMS) and/or the non-primary coro-
nary interventional hospital (transfer-
ring hospital), immediately recognize
a STEMI on an electrocardiogram
(ECG). EMS should immediately notify
the nearest appropriate receiving hos-
pital’s emergency department (ED)
that a STEMI patient is en route and is
to be transported immediately to the
catheterization lab, bypassing the ED.
AHAR will track each case’s adherence
to the national guidelines for heart
attack care.
Oversight for the AHAR is provided
by the STEMI Advisory Council (STAC),
a group of Arkansas-based health care
professionals including interventional
cardiologists, EMS professionals,
nurses and public health officials.
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