TUESDAY, April 16, 2002 (HealthDayNews) -- A meticulously planned trial program shows that many thousands of lives can be saved by reorganizing the emergency medical treatment system for heart attack patients.
Lives and money could be saved by having patients sent to community hospitals trained to perform emergency artery-opening procedures called percutaneous coronary interventions (PCI), says a report in the April 17 issue of the Journal of the American Medical Association. For the most part, PCI now is done only in major medical centers equipped for cardiac surgery. Other hospital emergency rooms treat heart attack patients with clot-dissolving therapy.
A study in which 11 community hospitals in Massachusetts and Maryland were trained to do PCI shows a clear life-saving benefit over clot-dissolving treatment, the journal report says.
"We're talking about 30 lives per 1,000 patients," says Dr. Thomas Aversano, associate professor of medicine at Johns Hopkins Medical Institutions, a leader of the trial. "That's a lot when you have 1.2 million cases a year."
There were other, equally striking benefits. Aversano says his team also saw a reduction of nearly 50 percent in strokes and second heart attacks for patients who got PCI rather than clot-dissolving therapy. And the average hospital stay for PCI patients was 4.5 days, compared to six days for those who received clot-dissolving treatment, a major financial saving.
Those results did not come easily, Aversano says. Planning for the trial began several years ago, after some published reports indicated a better outcome for heart attack patients who got PCI.
"That was a very exciting observation," Aversano says. "The problem is that access to PCI is limited. Only one-third of patients who have heart attacks are treated at places equipped for PCI. So you end up with two standards of care."
A first step in the trial was a three-month training program to familiarize the community hospital personnel with PCI procedures. Then came a logistic program to ensure that a heart attack patient got PCI within 90 minutes after arriving in the emergency room. Then there was a quality management program for data collection.
"But the important thing to get across is that PCI is not a therapy that begins in the emergency room," Aversano says. "In the real world, it begins in the ambulance ride, when the emergency medical service people perform an EKG to see whether the patient is a candidate for PCI."
So community-wide organization is required to get those patients to a PCI-equipped hospital, Aversano says. A model for such an organization exists -- the care of trauma patients, in which people who suffer major injuries are brought not to the nearest hospital but to specially equipped trauma centers. Achieving the same system for heart attack patients "will have to be decided on a case-by-case, locality-by-locality basis," Aversano says.
Planning for such a system has begun in Boston, says Dr. Christopher P. Cannon, a cardiologist at Brigham and Women's Hospital and author of an accompanying editorial in the journal.
There are nine hospitals in Boston, two of which do not offer PCI. Starting in July, data on heart attack treatment at all the hospitals will be monitored. "Then in December we will begin bypassing the hospitals that don't offer PCI to go directly to one that does," Cannon says.
The Boston program, which began 18 months ago, "is the beginning of a five-year process where we think of changing to a heart attack model based on the trauma model," Cannon says. "The trauma model is a clear precedent that is working very well."
But Aversano warns that implementing the change can be handicapped by a lack of resources. "There already is a strain on resources, especially human resources," he says. "It is incredibly difficult to find people who are capable of working in the cardiac catheter lab."
Nevertheless, change has to come, he says. "We cannot allow two standards of care, a good one and a better one," Aversano says. "We have to provide the greatest number of patients with heart attacks access to PCI."
What To Do
Any treatment for a heart attack is most effective when given quickly, so you should know the symptoms of a heart attack and seek help at once when they occur.
You can learn about the sometimes unclear symptoms of a heart attack and what to do about them from the American Heart Association, which also has a page on heart attack treatment.
