Study finds only 35% react quickly enough
By Steve Sternberg
USA TODAY
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All Rights Reserved
CHICAGO — Only about one-third of hospitals provide emergency care to heart attack patients quickly enough to meet scientific guidelines for saving lives, researchers report today.
Even top performers meet American Heart Association and American College of Cardiology (ACC) guidelines for care in only half their cases, researchers say.
“Even among the better hospitals, only a few hospitals routinely meet the recommended guidelines,” says Yale cardiologist Harlan Krumholz, a leader of the research team and an architect of a national campaign launched Sunday to help hospitals improve their performance. “By next year, we’re going to change that.”
About 200,000 people a year have heart attacks caused by blockages in crucial arteries supplying the heart with blood. About 10,000 patients die of these heart attacks in hospitals each year.
Studies show that reopening clogged arteries by inflating a tiny balloon at the site of the blockage is the best way to treat a severe heart attack. The procedure, balloon angioplasty, can cut a patient’s risk of dying by 40%, but only if it is done within 90 minutes of the patient’s arrival at the hospital, the so-called door-to-balloon time.
If every hospital met the guidelines, Krumholz says, doctors could save about 1,000 lives each year. A study out in March in the journal Circulation showed that 80% of people live within an hour’s drive of a hospital that provides balloon angioplasty.
Yet only about one-third of heart attack patients get angioplasty within the 90-minute window. The new study surveyed 365 hospitals to determine what procedures they have in place to get patients angioplasty quickly. Only 35% report an average door-to-balloon time of 90 minutes or less, 48% had a door-to-balloon time of 91 to 120 minutes, 13% came in at 121 to 150 minutes, and 4% topped 150.
The study, sponsored by the National Heart, Lung and Blood Institute, will be released today at an AHA meeting and has been posted online by the New England Journal of Medicine. Hospitals agreed to participate if they weren’t individually identified. Doctors said consumers can get an approximate measure of many hospitals’ response times by checking a U.S. government website.
The study was designed to help launch the new campaign, called D2B, for door-to-balloon, by providing hospitals with ways to improve performance. “We’re losing too many lives,” says Steven Nissen of the Cleveland Clinic and president of the ACC.
Momentum for change is building, Krumholz says, noting that hospitals, insurers and government agencies have signed on. Among the participants: United Healthcare, Premier Health Care Services, Aetna, Wellpoint Inc. and Blue Cross Blue Shield.
The study found that the system works best when:
*Paramedics perform an electrocardiogram en route to the hospital.
*The ER doctor uses it to activate the angioplasty team without waiting to consult with anyone else.
*A page operator can reach each member of the team, and they can arrive within 20 minutes.
*The hospital posts feedback on each case for the angioplasty and ER teams.
Whatever option is offered, minutes count. “You’ve had a heart attack. You’ve rushed to the hospital, and now you’re waiting for a procedure to open the blockage,” Krumholz says. “Most Americans wait two hours or more. And every minute you wait, your heart is being deprived of oxygen.”