Canadian Cardiovascular Society guidelines recommend that once eligible STEMI patients (patients experiencing a heart attack) present to the medical system (either Emergency Medical Services [EMS] or an Emergency Department [ED]), they should receive fibrinolytic therapy within 30 minutes or primary PCI within 90 minutes. Meeting these benchmarks requires looking at all aspects of a healthcare system including pre-hospital factors.
Alberta's Heart Attack Initiative is working to ensure that these guidelines can be met for all Albertans.
Here’s how it works
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A person experiencing chest pain calls EMS.
- When the paramedics arrive, they take an ECG and transmit it to a cardiologist or emergency doctor on call in Edmonton or Calgary.
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The doctor reads the ECG, talks to the paramedics and orders treatment – If fibrinolysis (i.e. drug therapy) is the preferred treatment option, the treatment will be administered immediately at the scene by the EMS crew, or the patient will be transported to the nearest Emergency Department for treatment (if EMS has not adopted a fibrinolytic program).
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If Primary PCI is the best reperfusion strategy for the patient, EMS transports the patient to the nearest cardiac catheterization lab.
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If a person experiencing chest pain goes to emergency, the attending nurse or physician has the option to send the ECG electronically to the cardiologist/emergency doctor on call for the Heart Attack Initiative. The ECG is read and the appropriate therapy is determined.
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If it’s drug therapy, a nurse can start therapy immediately, even if the physician on call for that site has not yet been able to get to the hospital.
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If it’s determined that it’s best to transport the patient to a tertiary care hospital, those arrangements can be made immediately.
Patient Follow-up
In Calgary, the existing STEMI program includes a post heart attack initiative to ensure that patients receive the post-treatment care they need in order to return to health. This includes ensuring patients receive self management education, clinical follow-up, appropriate drug treatment to lower cholesterol and blood pressure. Their research shows that follow-up is key to reducing returns to hospital and has become foundational to patient navigation work being done across the province (see Patient Navigation). The STEMI clinic model is a pilot for this project and will expand to include all low risk post heart attack patients after the pilot is complete.
In Edmonton/North post -STEMI follow up is monitored through the Safer Healthcare Care Initiative which is a national program, aimed at ensuring evidence-based discharge guidelines are implemented for all heart attack patients.
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