By Robyn Shelton
Orlando Sentinel
Copyright 2008 Sentinel Communications Co.
ORLANDO, Fla. — You can’t drive on Central Florida roadways without seeing the billboards.
In a promotional blitz aimed at heart patients, the area’s two largest hospital chains are touting their cardiology services to attract the thousands who go to ERs every year with chest pain.
Florida Hospital’s signs are adorned with “24-7,” a reference to its around-the-clock care at seven locations in Metro Orlando. A happy couple appear on billboards for Orlando Regional Healthcare beside the proclamation, “There’s a lot to love about ORMC heart care.”
Each hospital system hopes to position itself as a leader in heart services.
“Cardiology is the No. 1 moneymaker for most hospitals,” said Becky Cherney, chief executive of the Florida Health Care Coalition. “They want people to remember seeing that billboard, to plant the idea in people’s minds, so that if they ever have a heart event,” they head for a particular hospital.
Doctors say anyone with heart-attack symptoms should call 911 to be taken to the nearest hospital by ambulance.
Once there, the clock is ticking. For the most dangerous type of heart attack, the goal is to clear the blockage in a procedure called angioplasty within 90 minutes of arrival.
Both hospital chains have made changes recently to speed care for heart-attack patients.
*Florida Hospital now keeps staff on site 24 hours a day, seven days a week, for its cardiac-catheterization lab at its main campus on Rollins Avenue. This is where the hospital does angioplasties for these heart-attack patients. Those who go to other Florida Hospital locations are transported there. The permanent staffing eliminates any waiting for personnel to arrive at the hospital for emergencies after hours.
*Orlando Regional Healthcare recently began doing angioplasty for heart-attack patients at one of its outlying campuses, Dr. P. Phillips Hospital in southwestern Orange County. ORH used to offer the service only at its main hospital, Orlando Regional Medical Center in the downtown area. Now chest-pain patients at Dr. Phillips don’t have to be transferred, saving time.
ORH doesn’t staff its cath labs around the clock, but personnel are available at all times to come into the hospital for emergency cases.
Such efforts are part of a nationwide push to improve care for a particular kind of heart attack in which the entire artery is blocked. The medical term is ST-elevation myocardial infarction, or STEMI. About 400,000 of the more than 1 million heart attacks reported annually fall into this category.
Though not the most common attack, these blockages are more likely to be fatal.
Luis Davila, 37, had no idea he was facing a life-threatening emergency when he felt tightness in his chest after playing racquetball in March. The Orlando truck driver assumed it was muscle soreness. When the discomfort got worse throughout the evening, his wife drove him to the hospital.
They went to the nearest one: Florida Hospital East Orlando.
“Everything happened so fast; within 10 minutes of the doctor telling me that I was having a heart attack, I was on a helicopter,” Davila said. “They told me I was very lucky; I got there just in time.”
Getting ready for treatment
He was flown to Florida Hospital’s main campus, arriving just before 11 p.m. when the regular cath-lab shift normally would have ended. But with the permanent staffing in place, there was no waiting for workers to arrive to get him ready for treatment.
Heart-attack patients receive clot-busting drugs or angioplasty procedures to clear the blockages that stop blood flow to an area of the heart.
Studies have shown that STEMI patients fare better with angioplasty and when treated within 90 minutes of getting to the hospital. In angioplasty, a doctor inflates a tiny balloon inside the blockage to clear it.
Nationally, only about 40 percent of these patients undergo that procedure within that time frame, said Dr. Ralph Brindis, vice president of the American College of Cardiology. Only about 6 percent to 8 percent of patients transferred to another hospital receive treatment in the recommended time.
“The amount of time that the artery is totally closed determines how much heart muscle is lost, and there is a relationship between how much muscle is lost and the risk of dying,” said Brindis, a cardiologist in San Francisco.
Both Florida Hospital and Orlando Regional say they treat most patients in less than 90 minutes after arrival. But times can be much longer when a victim has to be flown from an outlying hospital.
Last year, patients who arrived at ORMC on average got angioplasty within 80 minutes. Those transferred from Dr. Phillips had an average treatment time of 118 minutes.
Now patients arriving at Dr. Phillips have their arteries reopened within the 90-minute benchmark, said Anita Loggins, patient-care administrator for the hospital. Dr. Phillips expects to treat about one STEMI patient a week, or about 50 cases a year. In all, Orlando Regional treated more than 180 STEMI patients in 2007.
“We determined that this approach is the best one for us, having this service where the patient needed it, when the patient needed it,” Loggins said.
Some controversy
The approach is not without controversy. As with many smaller facilities, the 150-bed Dr. Phillips hospital is not licensed to do open-heart surgeries. That means heart-attack patients who start with angioplasty and end up needing an emergency heart operation still will have to be transferred to ORMC. Time saved initially could mean time lost later.
At Florida Hospital, the administration has taken a different approach by centralizing care at one location and streamlining the “logistics” involved in transporting patients from other sites, said Danielle Johnson, assistant vice president of cardiovascular services.
Florida Hospital sees at least one STEMI case a day, treating more than 400 of these patients in 2007.
Johnson said the hospital had been staffing its cath lab during the overnight hours on weeknights already, but it has expanded coverage now to Saturday and Sunday as well. But hospitals need help cutting down the time to treatment.
Johnson said patients often downplay or ignore symptoms for hours.
“We really need to educate the community that chest pain is an emergency,” Johnson said. “If you have 20 minutes of chest pain at rest, you need to get to the nearest emergency room — fast.”