Table of Contents
REVIEW ARTICLE
Year : 2016  |  Volume : 1  |  Issue : 2  |  Page : 30-37

Public health interventions to improve access and quality of care for patients with acute cardiac events: Overview of the HeartRescue China program


1 Department of Cardiology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China
2 School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
3 Changning Disctrict Health Bureau, Shanghai, China
4 Chongming County Health Bureau, Shanghai, China
5 Department of Emergency Medicine, University of Arizona, Pheonix, Arizona, USA
6 RTI International, Research Triangle Park, North Carolina, USA
7 School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; RTI International, Research Triangle Park, North Carolina, USA

Date of Web Publication26-Dec-2018

Correspondence Address:
Prof. Feng Liu
Department of Cardiology Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, 118 Wansheng Street, Suzhou Industrial Park, Jiangsu Province
China
Prof. Zhijie Zheng
School of Public Health, Shanghai Jiao Tong University, 227 South Chong Qing Road, Shanghai 200025

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2470-7511.248363

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  Abstract 


Cardiovascular diseases (CVDs) remain the biggest cause of deaths worldwide. More than 17 million people die from CVDs annually. The HeartRescue Global Program is a five-year international healthcare program, sponsored by Medtronic Philanthropy and its partners, that supports community-based demonstration projects specifically designed to expand access to life saving interventions for acute cardiovascular events. Both global in scope and local in nature, HeartRescue focuses on working with healthcare partners in select communities in China, India, and Russia. The Heart Rescue Global Program will draw upon important lessons learned and expertise from within the on-going Heart Rescue-US Project. HeartRescue China has begun operating in select districts of China. This article focuses on introduces in details of the specific aims of the project, major components and activities, Expected Measurable Outcomes of the HeartRescue Program. This article focuses on and introduces in detail.

Keywords: Acute Cardiacevents, China HeartRescue, Public health


How to cite this article:
Liu F, Zhang L, Ge M, Xing J, You B, Zhang X, Shi O, Bobrow B, LaBresh KA, Trisolini MG, Zheng Z. Public health interventions to improve access and quality of care for patients with acute cardiac events: Overview of the HeartRescue China program. Cardiol Plus 2016;1:30-7

How to cite this URL:
Liu F, Zhang L, Ge M, Xing J, You B, Zhang X, Shi O, Bobrow B, LaBresh KA, Trisolini MG, Zheng Z. Public health interventions to improve access and quality of care for patients with acute cardiac events: Overview of the HeartRescue China program. Cardiol Plus [serial online] 2016 [cited 2020 Aug 5];1:30-7. Available from: http://www.cardiologyplus.org/text.asp?2016/1/2/30/248363




  Acute Cardiac Care in China Top


Cardiovascular diseases (CVDs) remain the biggest cause of deaths worldwide. More than 17 million people die from CVDs annually. Over 80% of CVDs occur in low- and middle-income countries, and an estimated 45% all CVD deaths are attributed to ischemic heart diseases, including acute myocardial infarction.[1] As China has grown economically, mortality due to ischemic heart disease has increased in incidence and has more than doubled during the last two decades to more than 1 million deaths per year. Over 500,000 out-of-hospital cardiac arrests (OHCAs) occur each year in China with the age-adjusted incidence measured at 71.2/100,000 residents in urban areas. Survival after OHCA, which averages around 10% in the United States, was recently shown to be just 1% in Beijing, China.[2] Quality of care has improved for some conditions in China, but important gaps in care persist. This is demonstrated by the fact that mortality has not decreased for the most deadly type of acute myocardial infarction ST-elevated myocardial infarction (STEMI).[3]

There are major barriers in the delivery and quality improvement for acute cardiac care [Figure 1].[4],[5],[6],[7],[8],[9],[10],[11],[12],[13] In China, the following barriers have been identified, together these issues have led to a sense of futility in respect to the potential for improving outcomes from acute cardiac events. Large and unacceptable disparities in care and outcomes exist in China for many groups including those who cannot afford care, cannot physically access care, or have limited knowledge of their condition, their local health-care system, or their rights as patients
Figure 1: Major barriers and potential interventions in the continuum of care for acute cardiovascular events

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  • No standardized measurement tool in place for measuring the incidence, process of care, and outcomes from either STEMI or cardiac arrest
  • Emergency medical service (EMS) systems in many communities in China lack adequate capacity to respond rapidly to acute CVD emergencies and are not well integrated with emergency dispatch or hospitals
  • Other EMS systems that do have capacity are not proficient in basic evaluation, stabilization, and resuscitation skills for patients suffering from acute cardiovascular emergencies
  • There are no specific programs in place to promote lay rescuer involvement or policies to protect lay rescuers from lawsuits, which has led to a culture where many potential lay rescuers are reluctant to perform bystander cardiac pulmonary resuscitation (CPR) for fear of negative legal ramifications
  • Public access defibrillation programs are only available in a few places.


Focused, coordinated national efforts are needed to improve the care and outcomes for patients with STEMI and OHCA in China, and system level data and more thorough implementation of each link in the “chain of survival” for patients suffering from STEMI and OHCA are needed.


  The Heartrescue® Global Program: Improving Access to Acute Cardiovascular Care Top


The HeartRescue Global Program is a 5-year international health-care program, sponsored by Medtronic Philanthropy and its partners, that supports community-based demonstration projects specifically designed to expand access to life-saving interventions for acute cardiovascular events [Table 1]. Both global in scope and local in nature, HeartRescue focuses on working with health-care partners in select communities in China, India, and Russia. The HeartRescue Global Program will draw on important lessons learned and expertise from within the on-going Heart Rescue-US Project (http://www.heartrescueproject.com/).
Table 1: Expected measurable outcomes of the HeartRescue program

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The aim of HeartRescue Global is to foster local ownership of each country program, to engage multi-sector stakeholders, including governments, medical professional societies, local health-care providers, patients, and families. The goal is to strengthen acute cardiovascular systems of care to enable people that have experienced an acute cardiovascular event as a result of underlying CVD to survive and go on to successfully manage their condition over the long term. In addition, improving access to acute care is essential to decreasing premature deaths due to noncommunicable diseases. Effectively addressing the acute care for ischemic heart disease, the largest contributor to overall cardiovascular death rates has the potential to lessen the overall burden of CVD, strengthen the overall systems of care in the geographies served, and improve patient outcomes and quality of life.


  HeartRescue China Top


HeartRescue has begun operating in select districts of Shanghai (Changning and Chongming County) and Suzhou (Suzhou Industrial Park), Jiangsu Province. The program includes the following components.

Community assessments

HeartRescue China is working with local partners to conduct needs assessments in each district to identify access-related barriers, service delivery gaps, community requirements, and opportunities within the acute health systems.

Demonstration projects

With results from the community assessments, HeartRescue China will engage multi-sector stakeholders to guide the program, to contribute to the design, and to award of multi-year grants supporting demonstration projects focusing on community-based interventions that leverage best practices and opportunities to integrate with existing health programs. These demonstration projects will work toward strengthening acute CV systems of care, enabling health-care providers to better address the needs of these populations, and supporting acute CV care-related advocacy and policy.

Management, measurement, and collaboration

During the implementation of the demonstration projects, HeartRescue China will manage and monitor the performance of the local initiatives to build capacity and provide technical assistance as needed. HeartRescue China will also facilitate routine information sharing and peer-to-peer learning among the partners and local stakeholders by convening technical fora and other events.

Evaluation

At the completion of the demonstration projects, HeartRescue China will conduct evaluations in the targeted geographies to assess the impact of the program. It is expected that the emerging best practices and lessons learned will guide future acute CV systems of care in China and beyond.

The specific aims of the project are as follows:

  1. To develop and implement a standardized and sustainable data collection and reporting system that will enable effective monitoring of the incidence, process of care, and outcomes from acute CVD allowing for accurate surveillance of high-risk populations and easy access to data for all community stakeholders
  2. To create an educational, online portal in multiple formats, including a Web site, mobile Apps, and WeChat-based subscriptions to support acute CVD education and training for the general population, patients, family members of patients, and health-care providers in basic and advanced cardiac resuscitation techniques as well as recognition of signs and symptoms of STEMI
  3. To improve the capacity and capability of the emergency call centers and dispatchers, EMS, and hospitals in the target districts of Shanghai to respond rapidly and effectively to patients with acute CVD events
  4. To engage the public in various settings (e.g., communities, schools, workplaces, and health-care facilities) to increase knowledge about acute CVD, CVD signs and symptoms, CPR, public access defibrillation, the components of the acute CVD chain of survival, and the HeartRescue China Program
  5. Engage local and national policymakers to consider potential policies, laws, and regulations that will improve opportunities for survival of patients with acute CVD events.



  HeartRescue China: A public Health Intervention Top


HeartRescue China is a public health intervention program which includes the following major components and activities.

Program development and stakeholder partnerships

Stakeholder partnerships have been developed in three implementation sites in the Shanghai region:

  • Suzhou Industrial Park – population of approximately 781,000; urban area of 802 km; located in the western part of Shanghai; served by 1 tertiary hospital, 2 secondary hospitals, and 1 community hospital, and the Suzhou Industrial Park EMS; key implementation partner is the Suzhou Kowloon Hospital (SKH)
  • Chongming County – population of approximately 670,000; rural area of 14112 km; located in the northern part of Shanghai; served by 1 general hospital, 8 secondary hospitals, 16 community health hospitals, and a county emergency medical center; key implementation partner is the Chongming County Centers for Disease Control (CDC)
  • Changning District – population of approximately 700,000; urban area of 382 km; located in the western part of downtown Shanghai; served by 5 tertiary hospitals, 10 secondary hospitals, and 10 community hospitals, and the Shanghai Central EMS; key implementation partner is the Changning District CDC.


The initial kick-off conferences for the HeartRescue China project were held in Shanghai and Beijing in October 2014. A National Advisory Committee (NAC) and a local Implementation Leadership Group (ILG) were formed at the October 2014 meetings. NAC and ILG met for a second time at the annual HeartRescue China meeting held in Shanghai in July 2015. Annual meetings of the NAC and ILG will be held each of the remaining years of this project.

The HeartRescue China interventions will be implemented in phases, with the first phase in the Suzhou Industrial Park site. During subsequent years, lessons learned from the initial interventions in the Suzhou Industrial Park site will then be applied in the other two implementation sites: Chongming County and Changning District. Informal meetings with stakeholders in all three implementation sites will be conducted during each year of the project to ensure ongoing involvement, commitments, and exchange of ideas and lessons learned.

A first step for the stakeholder partnerships at the Suzhou Industrial Park site will be to improve the linkage between the local community health center and the SKH. The SKH is the leader in CVD diagnosis and treatment in the Suzhou Industrial Park, and a partnership with the local community health center will enable SKH to expand its involvement with the local community and the population at higher risk for CVD and acute CVD events that are the focus for this project, including OHCA and STEMI.

Development of stakeholder partnerships with the local community is also a key element of the HeartRescue China interventions. The HeartRescue China team is developing an intervention plan for the Suzhou site that is focused on community members who are at high risk for CVD. We also met with community physicians and cardiologists at the SKH to discuss the community intervention processes and procedures, as well as the EMS and hospital interventions. HeartRescue China staff met recently with the SKH's President and Board of Directors regarding the hospital's partnership with the HeartRescue China project. Other major partners include Social Development Bureau of the Suzhou Industrial Park, the Suzhou EMS, Suzhou Center for Disease Control and Prevention, and Community Health Centers.

Standard care protocols for OCHA and STEMI will be developed and implemented using current Chinese EMS protocols and will be updated using the AHA guidelines, with translations and modifications for China. The HeartRescue China educational and intervention efforts will also be focused on ensuring that hospitals and EMS providers will fully follow the guidelines, which are often an issue in China. Training programs will also be important to ensure that hospital and EMS providers are able to fully follow the guidelines.

Registries, data systems, and information technology

A data registry system is being developed as a key tool for the HeartRescue China project, including detailed data collection on patients with acute CVD events, and monthly data reporting for quality improvement and feedback to providers. The data elements included in the data registry have been identified and compared with the data elements in the HeartRescue India program to ensure comparability of data collected across the two country programs and to provide opportunities to compare processes, quality measures, outcomes, and lessons learned across the two countries' HeartRescue interventions.

The data collection procedures for the data registry have been reviewed for all of the data elements. Development of digital data feeds has begun for some data elements not yet available in electronic format. The goal will be to pull in data from all of the hospital's systems into the registry. The interfaces are being developed with all of the hospital's systems, although this will take some time to complete and some manual data entry may still be needed during the 1st year of data registry operations. The goal will be to have all data in the registry electronically auto-populated, including time stamps for events in EMS, emergency department (ED), and hospital care. Data completeness and quality checks will also be automated. Another goal will be to enable all key data elements to be included as structured data and not as text data as some data elements are now, which also requires manual data abstraction or review.

To test the HeartRescue China data registry's data collection, analysis, and reporting procedures, a pilot study will be conducted by randomly selecting 20 STEMI patients. Data quality metrics will be calculated and assessed after completing the pilot study for more patients. The goal is to test quality measurement methods and produce reports that can be tested and refined in the pilot study. The quality measurement methods and reports can be finalized in Suzhou and then exported to the other two HeartRescue China sites in Shanghai.

A Web portal has been developed to provide information, education, and training resources for both health-care professional and for community members. The Web portal has now gone live and continued work is underway to develop a broader range of content and website links for both professionals and for the public. For example, training videos prepared for the May 5–6, 2016, Resuscitation Academy (RA) in Suzhou will be posted to the Web portal for ongoing use by health professionals and for training programs.

The Web portal lists a range of HeartRescue China partners and sponsors on its homepage. It includes separate sections for public education and for professional education. The public education sections will include presentations on what is cardiac arrest, what is STEMI, what are the signs and symptoms of OHCA and STEMI, and how to respond when those signs and symptoms are felt by patients or observed in other people. A focus for public response will be on calling the medical emergency telephone number, 1-2-0, quickly. There will also be sections for the public on how to perform CPR and how to use an automated external defibrillator (AED). Stories will be included about patients who have survived both OHCA and STEMI. An interactive chat function will be provided for public discussions and Q and A.

The professional education section of the Web portal will include CPR and STEMI diagnosis and treatment guidelines, from both China and the U. S. Links will be provided to training classes on high-performance CPR, STEMI treatment, and the chain of survival. Downloadable documents and training resources will be provided. News and updates on new methods in diagnosis and treatment for acute CVD will be posted regularly. An interactive chat function will be provided for professional discussions and Q and A. The Web portal will be publicized and disseminated through a mobile phone app and the popular Chinese social media site, WeChat, to encourage more active use.

HeartRescue China staff will conduct periodic evaluations of the Web portal and mobile phone app to assess the level of utilization and to solicit user feedback. The evaluation data will be used to update the content and identify ways to improve utilization.

Surveys of high-risk patients, community residents, and senior staff at hospitals and EMS will be conducted to ensure understanding of the main issues and needs regarding awareness of acute CVD, methods for community interventions, and diagnosis and treatment of acute CVD within the health-care system. The goal will be to identify barriers to providing high-quality acute CVD care at the community, EMS, and hospital levels. These surveys will be conducted in 2016 in conjunction with the HeartRescue China evaluation contractor, IHME.

Staffing, training, and community engagement

Training for emergency dispatchers/telecommunication staff, EMS staff, and hospital staff will be initiated in May 2016 at the first HeartRescue China RA that will be held over 2 days in Suzhou. The Suzhou RA will be modeled on the RA's conducted for the U. S. HeartRescue project and will include intensive training for EMS staff in high-quality CPR and STEMI treatment from international and Chinese experts in EMS systems and treatment protocols. The Suzhou RA will also provide intensive training in separate tracks for emergency dispatch/telecommunications staff and hospital staff, along with some combined plenary sessions that will include all of the attendees. The RA will emphasize to all participants the importance of comprehensive systems of care for OHCA and STEMI, their roles in that system, and how to coordinate with the roles of the other participants in that system.

The RAs will utilize a “train the trainers” approach so that the RA attendees in each of the sectors dispatchers, EMS staff, and hospital staff will then be able to pursue further training for themselves, follow-up with similar staff to provide on-the-job training, and help to build a culture of high performance and comprehensive systems of care for OHCA and STEMI. Annual HeartRescue China RAs will then be conducted at other project implementation sites in Shanghai in future project years.

Sessions for the emergency dispatchers/telecommunication staff will include identification of OCHA and STEMI, and telephone-guided CPR. Sessions for EMS staff will include AEDs, electrocardiograms (ECGs), indications of OHCA and STEMI, high-performance CPR, and use of medications. Sessions for hospital and ED staff will include use of AEDs, ECGs, indications of STEMI, high-performance CPR, speed of cardiac catheterization for STEMI, ICU care for OCHA and STEMI patients, and follow-up care after hospital discharge.

Following the RA, additional training will be conducted for Suzhou EMS staff on ECG, indications for STEMI, CPR, AED, and use of medications for acute CVD treatment based on Chinese clinical guidelines. Evaluations will be conducted on the basic life support (BLS), advanced life support (ALS), and first aid capabilities of the Suzhou EMS staff. This will also include the SKH ED staff in the Suzhou Industrial Park, as the SKH is in charge of ambulance services, EMS, and field treatment of emergencies. As a result, the ER doctors and nurses will also be provided with the additional training on ECG diagnosis, indications for STEMI, CPR, AED, and use of medications for acute CVD treatment based on Chinese clinical guidelines. These EMS training programs will be conducted by local clinical champions, and use training manuals developed for the HeartRescue China project from the Suzhou RA materials and other materials developed by HeartRescue staff and SKH staff.

In a parallel effort, HeartRescue China staff, SKH staff, and local clinical champions will develop certification standards for BLS and ALS providers, including EMS and ED staff. The EMS training programs will include online BLS and ALS modules to enable local EMs staff to earn certifications to provide increased recognition and motivation for them and to raise the visibility of the HeartRescue China project.

Furthermore, following the RA, additional training will be provided for Suzhou EMS dispatchers/telecommunications staff who are responsible for responding to the emergency telephone calls in the Suzhou Industrial Park implementation site. This will include additional training on early identification of STEMI and OCHA, telephone-guided CPR, and assessments of ways to improve the effectiveness of telephone-guided CPR within the local culture and community. This training, the assessment, and the quality improvement program for telephone-guided CPR in Suzhou Industrial Park will be led by a team of local clinical champions, SKH staff, and HeartRescue China staff. Training will also be provided to GPs on community surveillance and patient education. This will be conducted by HeartRescue China staff and local clinical champions.

Community education is another key element of the HeartRescue China interventions. This will include three elements. First, educating the community's general population on risk factors for CVD and the symptoms of acute CVD. Second, educating the population on the need to call the emergency telephone number, 1-2-0, or seek help from their GP immediately when those symptoms occur. Third, training for the population on bystander or family member CPR and educating residents on the importance of conducting bystander family member CPR when OHCA occurs.

Several methods will be used to provide the community education programs, including the HeartRescue China Web portal, social media contacts to push educational messages and programs to the high-risk populations using WeChat and other social media apps popular in China, and in-person classes conducted in local communities. Classes will be designed to be more interactive and engaging for community participants than the classes currently conducted for health education in many Chinese communities. Sponsors will include well-known national and local organizations to boost community enrollment, including the Red Cross, SKH, and the Suzhou EMS. Participants will be recruited from among high-risk individuals and their family members. The HeartRescue China program staff will supervise the curriculum, instructors, and teaching methods to ensure that participants master the basic skills needed.

The HeartRescue China community education and training programs will be developed and tested first with a population of approximately 1000 community members, over the age of 50–year-old, from two communities in the Suzhou Industrial Park site, including the Hudong community and the Ninghua community. An acute CVD emergency training center will be developed by assigning local GPs, EMS staff, and cardiologists, who will develop protocols for community education and training, design a training course, and then conduct the training course on this initial pilot testing population. The course will train high-risk individuals and their family members on the signs and symptoms of OHCA and STEMI, and what to do when they are found. The focus will be on simple and specific messages that can be widely understood by community members.

Lessons learned from this initial community education pilot, and training course will then be applied in subsequent years to improve the community education training protocols and the training course, expand the training to the other communities in the Suzhou Industrial Park, and to expand the training to the other HeartRescue China implementation sites in Shanghai. This phased implementation is illustrated in the HeartRescue China timeline and Gantt chart that accompany this intervention protocol narrative.

A challenge at present is that EMS directors report that the emergency 1-2-0 dispatchers respond more quickly when a GP calls than when an individual community member calls the 1-2-0 telephone number. The HeartRescue China program training and education programs will work with all of the community and EMS stakeholders to make sure that the emergency 1-2-0 dispatchers respond quickly when individual patients or family members call, as well as when GPs call. EMS staff reports that the dispatchers are sometimes not sure how fast to respond since individual patients and family members often sound confused on the telephone when they call 1-2-0. Training for individuals and family members in the community will help them to speak more clearly with the emergency 1-2-0 dispatchers. Furthermore, the emergency dispatchers will be trained to guide individuals through what to check for and what to do. The goal will be for the emergency dispatchers to provide more education and guidance to individuals and families and also to guide people on how to do CPR over the telephone. This training will be started at the RA that will be conducted in Suzhou in May 2016.

Another issue for the HeartRescue China community education program will be to train people in how to use AEDs. Most people in China report being afraid to use AEDs because they do not understand that AEDs are automated and very reliable. Most community members in China believe that AEDs are for health-care professionals to use and not for lay people such as themselves. As a result, AEDs are often locked up in China and not accessible to lay people when they are needed quickly to respond to OCHA. In addition, locking the AEDs up sends the wrong message to community members that the AEDs are not to be touched or used by lay people.

At present, legal protection from lawsuits is only provided to people in China who do CPR or use AEDs when they have a permit or legal license to do CPR or use AEDs. As a result, the initial training for the HeartRescue China project will emphasize family members for high-risk patients, as there is no need for people to be concerned about legal protection from lawsuits within families. Then, in parallel, the HeartRescue China project will work toward policy and legal changes to reduce the risk of lawsuits and to expand access to CPR and AED certifications or licenses.

Students will receive training and education on acute CVD symptoms, family member, or bystander CPR and AED use and how to call for help using the emergency 1-2-0 telephone number. Older community members will participate in community screening programs to identify people at high risk for acute CVD events, and they will also receive training and education on acute CVD symptoms, CPR, and how to call for help using the emergency 1-2-0 phone number. Work has begun on the development of educational materials for community members at high risk of CVD and their families. Focus groups on heart attack and CPR training contribute to these educational materials, which will be distributed through the HeartRescue China web portal and at community meetings.

The HeartRescue China program will also develop acute CVD survivor groups in the intervention communities in Suzhou and Shanghai. These survivor groups will be celebrated at community events by sharing how their lives were saved and helping to spread awareness of the benefits of training and education on acute CVD symptoms and responses.

Policy development

The HeartRescue China program will conduct ongoing consultation on acute CVD policy issues with government officials, legislators, medical professional societies, and opinion leaders. A White Paper with a call-to-action to improve acute CVD care will be developed. This White Paper will review the current status of acute CVD care in Chain, progress to date, and what is needed next to further improve care for the people of China. The White Paper will be modeled after the U. S. Surgeon General's reports. Experts will be called together from SJTU, Beijing University, professional societies and other sources to discuss methods for improving quality of acute CVD care. The White Paper will be limited in length to approximately 50 pages and published in both Chinese and English. This type of White Paper policy report will be new for China and is intended to influence Chinese policymakers and to gain visibility and coverage in the Chinese news media and social media. The White Paper will be used to increase awareness and communication about the HeartRescue China project and to promote policy and legislative change from policymakers and public opinion.

The HeartRescue China project will also work to develop legislation to influence policy and lawmaking in the local legislature of the Shanghai region. This can then be spread to local legislatures in other regions. For example, as noted, legal protection from lawsuits is now only available for doing CPR or using AEDs when a person has a permit or legal license. As a result, one type of model legislation will focus on providing expanded legal protection for bystanders doing CPR or using AEDs, similar to the “Good Samaritan” laws in the U. S., with appropriate modifications for the Chinese legal system and Chinese culture.

As an interim step, additional types of model legislation will be drafted to create new laws or regulations making it easier to obtain or maintain a CPR license. For example, removing the requirements for an annual CPR refresher course and improving access to standardized examinations to obtain a CPR license. These steps will allow individuals in the community, who have taken CPR training and can pass the examination, to obtain and more easily maintain a license or a certificate that will provide legal protection from lawsuits. These efforts would be in parallel with expansion of CPR and AED training in the community.

Additional model legislation will focus on promoting improved EMS system development, technical training, and human resource development at the local government level in the cities and counties in the Shanghai region. HeartRescue China staff will provide model legislative language, bullet points for talking with the news media, social media posts, building support from local stakeholders and in public opinion, aid local legislators in writing and negotiating the details of the legislation.

The HeartRescue China project will also develop and conduct policy conferences starting at the end of the 2nd year of the project as another method for improving acute CVD policy visibility and progress. The conferences will be hosted by SJTU and include a wide range of participants from the HeartRescue China project; including legislators, hospital staff, medical professional societies, government public health staff, university faculty, other stakeholders, and opinion leaders.

The HeartRescue China program will also develop an annual report starting at the end of the 2nd year of the project. The annual report will include a range of acute CVD policy and intervention activity reports, along with data to inform stakeholders and government officials of the progress of the project. In addition, stories of acute CVD survivors will be included to boost awareness and recognition of the benefits of the HeartRescue China program. The annual report will also document the range of activities and achievements of the HeartRescue China project. The annual report will be posted on the HeartRescue China Web portal and publicized through the news media and social media to boost readership.


  Conclusions Top


The HeartRescue Program focuses on the system of care that integrate pre-hospital, EMS, and in-hospital care. The success of this program will demonstrate the feasibility of the public health interventions aimed at improving access and quality of care for patients with acute cardiac events.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Clinical Research in Cardiology. 2020;
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