Heart Attack Treatment Speeds Up Nationwide

More get lifesaving angioplasty within 90 minutes of hospital arrival, study finds

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HealthDay Reporter

WEDNESDAY, Dec. 2, 2009 (HealthDay News) -- A nationwide program to get faster treatment for people with the most severe kind of heart attack has dramatically reduced the time between hospital arrival and lifesaving angioplasty.

More than three-quarters of people with STEMI heart attacks -- so called because of the electrocardiogram pattern that shows major blockage of a heart artery -- were receiving artery-opening angioplasty within 90 minutes of reaching a hospital in 2008, said a report released online Wednesday in advance of print publication Dec. 15 in the Journal of the American College of Cardiology.

Before the campaign began, in 2005, only half of those patients met the 90-minute deadline recommended for emergency angioplasty.

"It is a remarkable leap in performance, a tangible improvement in how people are being treated around the country," said Dr. Harlan M. Krumholz, professor of medicine at Yale University School of Medicine and an author of the journal report.

When the American College of Cardiology and 38 partner organizations set up what is called the Door-to-Balloon (D2B) Alliance, there were doubts that it could succeed, Krumholz said. The name is based on the angioplasty procedure, in which a thin, balloon-tipped catheter is threaded into a blocked heart artery, and the balloon is expanded to restore blood flow.

"There were warnings that we were setting up a situation where we all could fail," Krumholz said. "But all of a sudden people were saying, 'We can do this.'"

The report on 831 hospitals showed the 90-minute door-to-balloon deadline for STEMI heart attacks being met in 52.5 percent of cases in 2005. That number increased to 76.4 percent of cases in 2008.

And the improvement has continued, said the American College of Cardiology. Its most recent data, from June 2009, shows 81.7 percent of patients getting 90-minute door-to-balloon time. Also, the average time for start of angioplasty decreased from 121 minutes in 2005 to 80 minutes in 2009.

"I think we can say that in this country, the speed with which you are treated for a heart attack has improved no matter where you are," said Elizabeth H. Bradley, professor of public health at Yale and lead author of the journal report.

And while the study does not measure the effect of quicker treatment on outcome, "in the past couple of years, several studies have shown that reduction of door-to-balloon time is associated with improved patient survival," Bradley said.

Most of the changes prompted by the program were simple: Having ambulance attendants call the hospital to alert them that a heart attack victim was on the way, alerting the catheterization laboratory where angioplasty is done and the interventional cardiologists who do the procedure to be ready to go to work, and getting the patient to the catheter laboratory as quickly as possible, Bradley said.

But a key ingredient was a change in the mindset of the hospital personnel dealing with heart attacks, Krumholz said. "The important thing is that everyone felt they were working hard and fast before this," he said. "But the numbers showed they weren't. Then people came together and reworked the process by which these procedures were done."

Data on how much the program has improved survival might not be easy to obtain, because statistics do not separate out STEMI heart attacks -- "the crushing heart attacks that kill you," Bradley said.

But overall figures show "a marked reduction in heart attack mortality over this period," Krumholz said, and it can be assumed that the D2B program has a role in that reduction.

More information

Learn about angioplasty from the U.S. National Library of Medicine.

SOURCES: Harlan M. Krumholz, M.D., professor, medicine, Yale University School of Medicine, New Haven, Conn.; Elizabeth H. Bradley, Ph.D., professor, public health, Yale School of Medicine; Dec. 2, 2009, Journal of the American College of Cardiology, online

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