National Heart Attack Alert Program
National Heart, Lung, and Blood Institute
Coordinating Committee Meeting

March 22–23, 2004
Bethesda, Maryland

HIGHLIGHTS

Dr. Barbara Alving, Acting Director, National Heart, Lung, and Blood Institute, (NHLBI) welcomed the participants and introduced Dr. George Mensah, the new representative of the Centers for Disease Control and Prevention (CDC) on the Coordinating Committee. Dr. Mensah is the Chief, Cardiovascular Health Branch, of the National Center for Chronic Disease Prevention and Health Promotion’s Adult and Community Health Division at CDC. Dr. Alving also welcomed several substitute representatives.

• The focus of the meeting was on National Heart Attack Alert Program (NHAAP) Informatics Technology projects that were funded by the NHLBI and the National Library of Medicine. Reports on these projects were presented in three areas:
  • Phase I (patient delay). Dr. Thomas Aversano described the Patient-Initiated Emergency Response System (PIERS) project; Dr. Rita Kukafka described the MI-HEART project that examined the impact of tailored, Web-based health information; and Mr. Ransom Weaver described the Heart Sense video game to reduce heart attack prehospitalization delay.
  • Phase II (prehospital delay). Dr. Helmuth Orthner described Integrated Information Technologies for Emergency Medical Care, a project using upgraded voice/data communication in the emergency medical services (EMS) environment. Dr. Harry Selker described two pilot trials that used predictive instruments—one trial using a computerized electrocardiogram and another trial of the feasibility of using glucose, insulin, and potassium—in the prehospital setting to reduce mortality from acute coronary syndrome.
  • Phase III (hospital delay). Dr. Octo Barnett reviewed “Chest Pain: The First 60 Minutes,” a package of Web-based simulated patient cases and pre/post tests.

• After discussions of the presentations, Dr. Angelo Alonzo, Professor, Department of Sociology, The Ohio State University, Columbus, Ohio, reflected on the promise of informatics to promote early recognition and response to heart attack patients.
• Dr. James Atkins, Chair of the Executive Committee, reported on the Executive Committee meeting that was held earlier in the day and then introduced the subcommittee chairs for their reports on the subcommittee meetings that took place the previous day.
  • Mr. David Simmons, Vice Chair of the Education Subcommittee, reported on the Education Subcommittee meeting from the previous day that largely focused on progress and implementation of the “Act in Time to Heart Attack Signs” campaign through the Coordinating Committee organizations and in minority communities:
    • Ms. Terry Long, Senior Manager, Health Communications and Information Science, within the Office of Prevention, Education, and Control (OPEC) at NHLBI, gave a review and progress report on the “Act in Time to Heart Attack Signs” campaign.
    • Ms. Janet Kelly, Nutrition Education Specialist, OPEC, NHLBI, described her and others’ work implementing the “Act in Time to Heart Attack Signs” small group session kit with American Indian and Alaska Native groups.
    • Ms. Lenee Simon, Community Health Specialist, OPEC, NHLBI, presented an overview of a pilot project with the Housing Authority of Baltimore City, which introduced the “Act in Time to Heart Attack Signs” small group session to the public housing community.
  • Dr. Bruce MacLeod, Chair of the Health Systems Subcommittee, reported on the meeting that took place the previous day. The subcommittee discussed the following issues:
    • The Subcommittee discussed a revised paper on “Use of EMS by Patients with Acute Coronary Syndromes (ACS)” that will be used as a background paper for the October 2004 meeting and has been submitted for publication.
    • Ms. Mary Beth Michos, Subcommittee Vice Chair, reviewed the draft agenda for the October 2004 meeting for EMS Stakeholders, to problem-solve around issues related to improving EMS utilization by ACS patients.
    • Dr. J. Lee Garvey, representative of the Society of Chest Pain Centers and Health Systems Subcommittee member, presented a draft paper for Subcommittee discussion entitled “Prehospital 12-Lead Electrocardiography—A Call for Implementation in EMS Systems Providing Advanced Life Support.”
    • Dr. MacLeod reported on his and the NHAAP Coordinator’s interim discussions with the National Committee for Quality Assurance, about a quality indicator for ACS patients related to utilization of EMS.
  • Dr. Joseph Ornato, Chair of the Science Base Subcommittee, reported on the Science Base Subcommittee meeting from the previous day:
    • The Science Base Subcommittee reported on their (every other meeting) review of the Literature in four broad areas: Phase I, Patient/Bystander Aspects and Actions; Phase II, Prehospital Aspects and Actions; Phase III, Hospital Aspects and Actions; and Phase IV, General/Crosscutting Aspects and Actions.
    • For each topic within the areas, they considered: the state-of-the-science; any apparent trends; recent groundbreaking studies that warrant discussion by the Science Base Subcommittee; and the topic’s impact on the efforts of the NHAAP.
    • Then Ms. Mary Hand, NHAAP Coordinator, and Dr. Teri Manolio, Director, Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, NHLBI, gave an update on their efforts to address the Science Base Subcommittee priority area of the establishment of an ACS patient surveillance system.
    • Dr. Robert Christenson, representative of the American Association for Clinical Chemistry, Inc., reported on the work of the National Association of Clinical Biochemistry Committee to update the Laboratory Medicine Practice Guidelines for Biochemical Markers for ACS, and on the May 2004 Beckman Conference, the forum in which the draft guidelines will be discussed. NHAAP professional organizations were invited in late 2003 to designate a representative to the guidelines development process.
    • Finally, Dr. Joseph Ornato presented an update on the Public Access Defibrillation (PAD) study, as part of his report.
• Mr. Drew Dawson, representative of the National Highway Traffic Safety Administration (NHTSA), provided an update on an Institute of Medicine report on the future of emergency care in the U.S. health system, which will be expanded, with the help of the NHTSA, to include prehospital EMS.