November 13, 2006
Hundreds of U.S. hospitals have agreed to step up their response to heart attack cases by clearing blocked arteries within 90 minutes of a patient's arrival in the emergency room, as treatment guidelines recommend.
Fewer than a third of such patients now get the recommended treatment, angioplasty. The risk of death risees 42% if care is delayed for even half an hour, studies have found.
The campaign targets heart attacks caused by blockage of a major artery that prevents oxygen from reaching the heart. About a third of the 865,000 annual heart attacks in the U.S. fall into this category.
Angioplasty involves snaking a tube through a blood vessel to the blockage and inflating a tiny balloon to open the artery. A stent is usually placed in the artery to prop it open.
Guidelines have long called for a "door to balloon" time of 90 minutes but many hospitals have not set up well-tested procedures to achieve that goal.
Yale University researchers Elizabeth Bradley and Dr. Harlan Krumholz surveyed 365 hospitals and found six measures that cut the time between the patient's arrival and the actual procedure.
The strategies include:
• Having emergency room physicians activate the catheter laboratory as quickly as possible.
• Having a single call to a central page operator activate the laboratory.
• Having the emergency room activate the catheter lab while the patient is en route to the hospital.
• Expecting the staff to arrive at the laboratory within 20 minutes of being paged.
• Having an attending cardiologist always on site.
• Having hospital staff provide real-time data feedback about their performance.
Hospitals say there's little cost involved in implementing the new procedures. One researcher said hospitals now waste too much time summonizing various doctors and technicians individually, instead of having a single "cath call" system.
The program is being launched today at an American Heart Association conference in Chicago.
Major medical groups and government agencies have endorsed the project, including the National Heart, Lung and Blood Institute.
