A PROVINCIAL APPROACH TO IMPROVING STEMI CARE IN ONTARIO

Abstract

The Cardiac Care Network of Ontario (CCN) is dedicated to improving the quality, efficiency, access and equity in the delivery of adult cardiovascular services in Ontario. CCN works to plan, coordinate, implement and evaluate adult cardiovascular care in the province of Ontario, and is responsible for the CCN Cardiac Registry, a clinical data registry that includes all cardiac procedures in Ontario. CCN established a STEMI Working Group (membership comprised of representatives from PCI and Non PCI hospitals, Emergency Medical Services and Base Hospitals) to conduct a current state assessment and standardize care for ST elevation myocardial infarctions (STEMI) in Ontario. Seventeen hospitals in Ontario provide Percutaneous Coronary Intervention (PCI) of which 6 are Stand Alone PCI programs (without on-site cardiac surgery). Data from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD) suggest that the incidence of STEMI in Ontario is approximately 68 per 100,000 adult residents, providing an estimate of 7,000 STEMIs per year. STEMIs are treated through the restoration of blood flow in the coronary artery through one of two treatment options or “reperfusion” modalities:-Primary PCI-Fibrinolysis Therapy-Pharmaco-invasive Therapy. In order to determine the current state of care for STEMI patients, the CCN STEMI WG conducted a survey of emergency services, PCI hospitals and non PCI hospitals. The results of the environmental scan, combined with analysis of administrative data, review of best practice guidelines and published literature, provided the foundation for 16 recommendations to optimize STEMI care in Ontario, of which five were identified as priority recommendations. In December 2013 the Auditor General of Ontario reviewed the Land Ambulance service in Ontario, and included CCN STEMI WG’s recommendations in its report to the Ontario government. CCN has expanded its Cardiac Registy to include metrics related to quality indicators for STEMI care to monitor performance of the STEMI system in Ontario. CCN’s recommendations for a province-wide, standardized and coordinated approach to STEMI care will help to decrease the variation in the use of pre-hospital care resources, improve coordination of care and access to PCI, and as a result, improve patient outcomes (e.g., reduced morbidity and mortality) as patients receive the right care (reperfused) in the right place (PCI Centre) at the right time (within the recommended timelines).