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Consortium to Improve Care for Heart Attack Patients in

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Duke Health News 919-660-1306

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 organizer 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, Durham, 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 huge problem with coordination and access."

"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 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 EKG
machines in ambulances, so vital data on 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.

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