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VHAC Meeting Recap — Standardize. Share. Move Faster.
- Sherri White
- 6 days ago
- 5 min read
Held at Lewis Ginter Botanical Garden, Richmond • 2025 Fall Statewide Meeting
Virginia is tightening cardiovascular care by standardizing pathways, expanding registry coverage, and attacking stubborn delay—especially in the ED. The day hinged on two anchors: State of the State from Peter O’Brien, MD — Co-Founder, VHAC (Centra Lynchburg) and a cardiogenic shock deep-dive from Shashank Sinha, MD (Inova Fairfax).
State of the State — Peter O’Brien, MD — Co-Founder, VHAC (Centra Lynchburg)
Dr. O’Brien didn’t mince words: Class I STEMI systems must function in every region—not just on slides. He reiterated VHAC’s three pillars—regional collaboration, EMS engagement, and data—and called out uneven performance that hides preventable delay. Virginia’s wins are real (near-universal prehospital 12-lead acquisition and tighter FMC-to-device times), but the mandate is sharper: finish onboarding the remaining PCI centers to the STEMI registry, compress ED time, and use transparent data to change behavior. He also announced the newly established VHAC Board of Directors, formalizing governance and member input to accelerate decisions and accountability. Looking ahead to 2026, the coalition will assess adding cardiac arrest systems of care, formalize ties with stroke networks, and prepare for AI-assisted STEMI/OMI detection as approvals evolve.
Spotlight: Cardiogenic Shock — Shashank Sinha, MD (Inova Fairfax)
Dr. Sinha delivered an evidence-first review with uncomfortable truths. Diagnosis and classification remain complex, and that ambiguity harms patients. Invasive hemodynamics (PA catheter) should guide real-time decision-making; guessing is not a plan. Evidence for
temporary mechanical support is mixed across IABP-SHOCK II, ECLS-SHOCK, and DANSHOCK, so the pragmatic focus is early recognition, complication reduction, and team-based pathways. He emphasized that registry participation is leverage: the AHA Cardiogenic Shock Registry (120+ sites nationally, only ~3 in Virginia) provides benchmarking and process metrics we simply don’t have at scale. While it requires dedicated FTE resources, it prevents programs from operating without critical visibility.
The takeaway was focused—standardize shock pathways now and commit to registry participation so survival and complication rates improve for the right reasons, not anecdote.
Celebrating Our AHA Award–Winning EMS Agencies
Congratulations to the Virginia agencies recognized with 2025 AHA Mission: Lifeline EMS Awards and System of Care Target Distinctions (Heart Attack and Stroke). These honors reflect disciplined protocols, rapid ED→cath/CT activation, strong EMS–hospital communication, and relentless data submission. A special shout-out to the Chesapeake Fire Department—Gold with Heart Attack Distinction—for joining us in person at the VHAC meeting. To all awardees: thank you for proving that standard work saves minutes and lives. We invite recognized agencies to share brief “what worked” summaries or tools so peers across the Commonwealth can accelerate adoption ahead of the next award cycle.
Regional Updates — Northwestern, Southern, Western, Northern, Central, and Eastern.
Across Virginia, the regional reports read like a statewide pivot. Northwestern is locking in a disciplined cadence for shared data review; Southern showed that early activation and targeted education are already pushing FMC-to-device times down; Western owned the
work ahead on door-to-balloon, committing to a cleaner ED→cath handoff with EMS; Northern, under new leadership, is tightening loops for data, education, and process maps to drive out variation; Central is aligning prehospital-to-ED-to-cath dashboards so everyone is working off the same numbers; and Eastern is scaling ED-bypass protocols and EMS ECG education to make direct-to-cath the norm. The signal is unmistakable: when EMS, ED, and cath leaders meet around the same metrics, minutes fall and outcomes rise. Each region left with a playbook, a metric, and a promise—take what works, spread it, and come back with proof.
Workgroup Updates — ED Bypass, Shock, PERT, EMS ECG, Thrombolytics
Workgroups moved from theory to playbook. The ED Bypass (Direct-to-Cath) update was presented by Dr. Kaushik (Bon Secours), translating literature and survey findings into an action plan to cut handoffs—and minutes. The Cardiogenic Shock update was presented by Dr. Berzingi (Carilion) outlining early identification, invasive hemodynamics, and clear escalation logic. PERT (PE Response Teams) was presented by Dr. Michael Kelley (Carilion), sharing statewide criteria, interdisciplinary activation, and early data from 20 cases across two sites. ECG Education was presented by Bob Page, doubling down on clean lead placement, skin prep, and deploying 15-lead ECGs when indicated to boost STEMI sensitivity. The Thrombolytics segment was presented by Dr. Michael Kontos (VCU), clarifying when and where fibrinolysis fits inside a modern STEMI system to avoid paralysis in borderline scenarios. Members were asked to identify which groups should continue, sunset, or start—based on impact and adoption, not habit.
Data & Operations — Registry Coverage, Film Review, and Practical Levers
VHAC’s statewide view remains incomplete until all PCI centers are contributing to the STEMI registry. The VCSQI Angiogram Film Review Initiative—a free, independent look at cath films—was highlighted as a practical way to de-bias case review and improve technique and decision-making. Signals from partner programs on TAVR efficiency and Patient Blood Management reinforced that cutting waste wins: pre-op anemia workups, tighter selection, cleaner workflows, IV iron, and point-of-care coag testing reduce complications and cost. The reality check: data definitions, staffing, and submission discipline still vary, skewing comparisons and hiding failure modes. Economics are shifting; leadership will back what cuts complications and dollars—with proof.
VCSQI/VHAC offers a free, independent angiogram film review service to help cath teams spot practical improvements in technique and decision-making—from access and imaging quality to lesion assessment, device selection, and timing. Cases are de-identified, feedback is concise and actionable, and you can use the results in your next cath conference to drive measurable quality gains. If your site would like to opt in (set your own cadence, start with a small batch) or opt out (no pressure), please select the appropriate button below or contact Sherri@vcsqi.org and we’ll note your preference.
VHAC Interactive Trivia Breakout — Hosted by Bob Page
To reset the room and sharpen fundamentals, Bob Page led a fast-paced VHAC Cardiac Interactive breakout—live polling from phones, team scoring, and escalating difficulty. Questions hit practical ECG essentials (clean lead placement/skin prep, 15-lead use when indicated) and clinical calls like RVI recognition in V4R. The competition turned skills into muscle memory, kept engagement high, and underscored why small technical habits change door-to-device times. Congrats to the top scorers and teams for setting the pace—this is exactly how we turn education into execution.
Virginia isn’t waiting for permission—we’re standardizing care, publishing the data, and cutting the delays that still cost patients time and outcomes. Dr. O’Brien’s State of the State set the mandate: finish STEMI registry onboarding and make Class I systems real in every region; Dr. Sinha’s shock deep-dive showed how—early recognition, invasive hemodynamics, and disciplined team pathways backed by registry proof. With a newly established VHAC Board of Directors to drive accountability, the path forward is simple: recruit the remaining cath labs, tighten ED-to-cath flow, expand workgroup adoption, and measure what matters. Bring this home to your EDs, cath labs, and EMS partners. When the registry is complete and the playbook is used every time, Virginia will be the state that turned standards into survival.
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Need materials?
If you missed a segment or want to review a deck, access the meeting recording and slides here: https://www.vaheartattackcoalition.org/statewide-meeting/2025-statewide-meeting. If you need permissions, contact Sherri (Sherri@vcsqi.org) and we’ll get you set up.
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