How the MISSION! Protocol is Transforming Heart Attack Care
Imagine a world where every heart attack patient receives perfectly coordinated, evidence-based care from the first 911 call through long-term recovery. A world where geographic location, hospital type, or sheer luck no longer determine survival odds. This isn't medical fantasy—it's the reality being created by the revolutionary MISSION! protocol.
Myocardial infarction (MI), commonly known as a heart attack, remains a leading global killer and primary driver of heart failure worldwide 5 . Despite well-established treatment guidelines, studies consistently show a troubling gap between recommended care and real-world practice. This implementation gap isn't just theoretical—it translates directly into lost lives, reduced quality of life, and soaring healthcare costs. Enter MISSION!, an integrated care model turning the impossible into "I'm possible" for thousands of heart attack patients 1 3 8 .
When a coronary artery becomes completely blocked, the clock starts ticking. Heart muscle cells begin dying within minutes, creating what doctors call the area at risk (AAR).
The ultimate infarct size (IS)—the permanent damage—depends on how quickly blood flow can be restored. This damage directly determines survival odds and future heart function 5 .
While we've known for decades that rapid reperfusion (opening blocked arteries) and specific medications dramatically improve outcomes, consistent implementation has remained elusive. Studies reveal significant variations in:
This implementation gap inspired Dutch cardiologists to develop a revolutionary solution—the MISSION! protocol.
What makes MISSION! revolutionary isn't a single breakthrough drug or device, but its comprehensive re-engineering of the entire patient journey across three seamless phases 8 :
| Performance Indicator | Pre-MISSION! | Post-MISSION! | Improvement |
|---|---|---|---|
| Door-to-balloon time | 94 ± 33 minutes | 58 ± 18 minutes | 38% reduction |
| Discharge on β-blockers | 75% (historical) | 86% | 11% increase |
| Discharge on statins | 80% (historical) | 99% | 19% increase |
| Average length of stay | 7.2 days | 3.7 days | 49% reduction |
| Blood pressure control | Not reported | 91% at 1 year | New standard |
The true test of any medical protocol isn't in theory, but in the messy reality of regional healthcare systems. The MISSION! team launched their protocol in the challenging environment of the Dutch "Hollands Midden" region—750,000 people served by three community hospitals without PCI capabilities, ambulances, rehabilitation centers, and one academic PCI center (Leiden University Medical Center) 8 .
Established secure ECG transmission from ambulances to the PCI center, allowing catheterization teams to activate before patient arrival.
Developed standardized order sets, flowcharts, and stickers ensuring consistent care across facilities.
Created accessible educational materials and websites to engage patients in their recovery.
Implemented the CARIS electronic data system to track 22 quality indicators across all care phases.
The pilot's outcomes were nothing short of transformative. Beyond the dramatic door-to-balloon time reduction, the team achieved near-perfect adherence to discharge medications (99% for statins and clopidogrel, 93% for ACE inhibitors) and significantly shortened hospital stays. Perhaps most impressively, 64% of uncomplicated patients were discharged within three days—previously unheard of in MI care 8 .
While MISSION! addresses clinical implementation, another crisis plagues MI therapeutics: the preclinical translation gap. Promising animal studies routinely fail in human trials, wasting billions and delaying progress. A landmark meta-analysis revealed why :
Researchers analyzed 246 studies (1,500 large animals) and discovered that infarct size and cardiac function measurements varied dramatically based solely on study design choices:
| Experimental Variable | Impact on Infarct Size | Functional Consequences |
|---|---|---|
| Species: Dog vs. Pig | 22% smaller in dogs | Better EF in dogs |
| Sex: Female vs. Male | 6-10% smaller in females | Reduced remodeling |
| Co-medication: Yes/No | 18% reduction with meds | Preserved function |
| Occlusion Type: Temporary vs. Permanent | 11% larger with permanent | Worse functional recovery |
| Vessel: LAD vs. LCX | 15% larger with LAD | Greater functional impact |
| Ischemia Duration | +0.21% per minute | Linear function decrease |
The Takeaway: These variations make cross-study comparisons nearly meaningless and highlight why therapies tested in poorly designed models fail human trials. The solution? Standardized models that better mimic human MI pathophysiology and account for these variables.
The MISSION! protocol provides the implementation framework—now emerging technologies promise to amplify its impact:
Machine learning algorithms analyzing real-world data from systems like CARIS can identify subtle patterns humans miss, enabling predictive interventions before complications develop. Similar AI approaches are already transforming cancer care 9 .
The next frontier focuses on molecular recovery. Promising targets include:
The MISSION! protocol represents more than incremental improvement—it's a fundamental reimagining of how we approach acute cardiovascular care. By breaking down silos between prehospital teams, hospitals, and rehabilitation services, and by rigorously implementing known best practices, MISSION! achieves what previously seemed impossible: consistently excellent care for every heart attack patient, regardless of where they live or which hospital door they enter 8 .
Meaningful progress is possible, and it only happens with bold investment and active collaborations 6 . This truth resonates powerfully in cardiology. With integrated models like MISSION! providing the implementation blueprint, and emerging technologies offering new therapeutic possibilities, we stand at the threshold of a new era in heart attack care—one where optimal treatment isn't the exception, but the guaranteed standard.