Key Steps Speed Heart Attack Care

All U.S. hospitals should follow these six rules, researchers say

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By Ed Edelson
HealthDay Reporter

MONDAY, Nov. 13, 2006 (HealthDay News) -- Anyone who has had a heart attack understands how crucial each minute becomes.

Now, a new study presents key strategies that quicken "door-to-door" delivery of lifesaving angioplasty whenever heart attack strikes.

The goal for the researchers is to make this type of care standard in hospitals nationwide.

"We want to take what is idealized care and make it routine so that you know that wherever you go, you get the best care," said study senior author Dr. Harlan Krumholz, a professor of medicine at Yale University.

His team was expected to present its results Monday at the American Heart Association annual meeting, in Chicago. The study will be also published in the Nov. 30 edition of the New England Journal of Medicine, but is being released ahead of time to coincide with its presentation at the meeting.

While heart attacks are all too common in the United States, a typical hospital emergency room may deal with someone presenting symptoms perhaps once a day. Krumholz said. The ideal is to get a patient into angioplasty -- where doctors insert a catheter to re-open a blocked artery -- within 90 minutes.

This study of 365 U.S. hospitals found that the time needed to perform this door-to-door delivery of care in their "catheter labs" ranged anywhere from 55 to 120 minutes, however.

"We asked all sorts of questions about their strategies -- how they get things in motion and so on," Krumholz said. "All had been reporting door-to-balloon time, so we were able to correlate which of the 28 features were most closely associated with fast time to balloon."

The six strategies identified in the study included:

  • 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.

Much of this type of data has never been available to hospital medical teams, Krumholz said.

"There has been evidence about how you excel in treatment, but no one really has explained how to do it," he said. "We are coming late to this in health care."

Feedback is important, added Dr. Mauro Moscucci, director of interventional cardiology at the University of Michigan and co-author of an accompanying editorial. "We occasionally see that the system breaks down. If we can analyze what happens in those situations, feedback can result in improvement," he said.

Breakdowns occur because "care of heart attack patients involves different departments and different health providers," Moscucci said. "We need the appropriate culture to work within the system. There needs to be collaboration."

The important point is that strategies for improving treatment have now been identified, Moscucci said. "Now, we have the data," he said. "We know what needs to be done. We must convince hospitals that this is what they need to do."

A program to implement the findings, sponsored by the American Heart Association, the American College of Cardiology and the U.S. National Heart, Lung, and Blood Institute, among others, has already been launched, Krumholz noted.

"We have 200 hospitals signed up," he said. "We want to get every hospital in the country to do it."

More information

Learn about the signs and symptoms of a heart attack at the American Heart Association.

SOURCES: Harlan Krumholz, M.D., professor, medicine, Yale University, New Haven, Conn.; Mauro Moscucci, M.D., director, interventional cardiology, University of Michigan, Ann Arbor; Nov. 13, 2006, presentation, American Heart Association annual meeting, Chicago; Nov. 30, 2006, New England Journal of Medicine

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