The American Heart Association (AHA) issued a scientific statement Aug. 13, stating that their guidelines now recommend that paramedics perform and evaluate a prehospital ECG routinely on patients with chest pain suspected of having STEMI.
AHA acknowledged that the central challenge for healthcare providers is not to simply perform a prehospital ECG, but to use and integrate the diagnostic information from a prehospital ECG with systems of care. The potential savings in time from first medical contact to reperfusion therapy by integrating prehospital ECGs with hospital systems of care are considerable and clinically relevant, according to the association.
However, AHA said that the gaps between use under ideal circumstances and in routine practice remain substantial, stating that there are many logistic barriers, including the need for increased patient use of EMS; increased EMS capacity; improved education and quality assurance for EMS providers; improved collaboration among EMS, emergency departments and cardiology; improved organization of hospital systems and providers; and improved coordination of regional hospital networks to provide the ideal patient care rather than optimize market share.
The association also noted the financial barriers, including reimbursement and cost-effectiveness of the diagnostic technology, which will need to be overcome for prehospital ECGs to gain widespread support across payors, providers, and healthcare systems.
However, the AHA said that the barriers are not insurmountable and can be overcome with dedicated efforts to improving systems of care. Future investigations and policy measures are needed to encourage EMS, hospitals and healthcare systems to adopt and maximize the full potential of this technology, as well as monitor unintended consequences, AHA said.
The association said it is hoping to address many of these barriers with the American Heart Association’s Mission: Lifeline, a national initiative launched in 2007 to improve systems of care for patients with STEMI. Working in collaboration with EMS organizations on national and local levels, Mission: Lifeline is conducting a survey to determine EMS capability, policy, infrastructure, and resources, including prehospital ECG capability and protocols for care of patients with STEMI.