RACE Aims to Save Lives
By Doug Boyd
With an eye toward saving time and saving lives, East Carolina University physicians and others are participating in a statewide project aimed at streamlining the care heart attack patients receive.
With organization and support from Pitt County Memorial Hospital, cardiologists and emergency physicians at the Brody School of Medicine, local private-practice cardiologists, and doctors and hospitals across eastern North Carolina are working together as part of a statewide consortium of health care providers and Blue Cross and Blue Shield of North Carolina. The consortium calls its project RACE, short for Reperfusion of Acute M.I. in Carolina Emergency departments.
“We know from multiple sources that patients in North Carolina are not getting potentially life saving therapy often enough or soon enough,” said Dr. Joseph Babb, a professor and cardiologist at the Brody School of Medicine and director of the cardiac catheterization laboratories at PCMH. With the knowledge and practice gained in the RACE project, he added, patients benefit “by receiving appropriate therapy more rapidly and, if hospital transfer is needed, realizing said transfer in a more expedited fashion.”
The issue is especially important in North Carolina, RACE team members said, since national registries have shown that only about 60 percent of North Carolinians who come to an emergency room with symptoms of a myocardial infarction, or heart attack, receive potentially life-saving reperfusion therapies to open their clogged arteries, compared to the national average of at least 70 percent. National benchmarks are for patients to receive drugs within a half-hour and angioplasty, if needed, within 90 minutes.
Angioplasty is the use of a balloon threaded through the arteries to the blockage and then inflated to reopen the artery, restore blood flow and spare damage to heart muscle due to a lack of oxygen.
If successful, RACE could serve as a national model for collaborative efforts to improve delivery of emergency care.
The RACE consortium comprises five regions centered in Greenville, Durham/Chapel Hill/Greensboro, Winston-Salem, Charlotte and Asheville. 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. Blue Cross Blue Shield of North Carolina is supporting the project with a $1 million grant.
Throughout the two-year project, RACE researchers will collect data on heart attack patients who receive treatment as well as those who would have been candidates for reperfusion therapy but did not receive it. The goal is to streamline patient evaluation and treatment. Reperfusion therapies involve using either a clot-dissolving drug or angioplasty. Clot-dissolving drugs are available at most hospitals, but angioplasty is not as widely available.
“We have looked at the entire sequence of events when a patient is having a heart attack, from the time EMS is called until the blocked artery is opened up, in order to shorten the time and save more heart muscle and more lives,” said Dr. Joseph Shiber, assistant clinical professor of emergency medicine at ECU.
In addition to streamlining care, RACE organizers aim to improve outcomes of heart attack patients by funding educational nursing programs, conducting physician seminars on reperfusion therapies, providing emergency room guidelines and expanding the use of EKG machines in ambulances, so vital data on patients’ hearts can be transmitted ahead to emergency personnel.