By Sandy Miller
Times-News (Twin Falls, Idaho)
Copyright 2006 Times-News
Distributed by McClatchy-Tribune Business News
TWIN FALLS, Idaho — When it comes to unblocking a heart artery with angioplasty, turns out Twin Falls is a good place to be.
In fact, it was the best place to be in the first two quarters of 2006, according to recent studies by the American College of Cardiology. St. Luke’s Magic Valley Regional Medical Center ranked number one out of more than 500 hospitals surveyed for its “door-to-balloon” time. Simply put, that’s the time it takes between a patient reaching the hospital’s doors to having a heart artery unblocked with angioplasty, a procedure in which an expandable balloon is passed to the blockage and inflated, compressing the plaque and stretching the artery open.
Patients with clogged arteries got them unclogged faster at their local hospital than patients did at more than 500 other hospitals across the U.S., including some prestigious big-city hospitals.
The study looked at the percentages of patients who had angioplasty procedures performed in less than 90 minutes after arriving at the hospital doors. The national average in the first quarter of 2006 — January through March --was 52.7 percent. The national average for the second quarter of 2006 — April through June — was 55.7 percent.
At St. Luke’s Magic Valley Regional, 100 percent of heart patients who came through the hospital’s doors had their arteries unblocked in less than 90 minutes. Even Dr. Daniel Brown, one of two local interventional cardiologists, was amazed to see the hospital top the list two quarters in a row.
When he saw the first quarter’s results, he said, “Gee, we got lucky.”
What did Brown think when he saw the second quarter results?
“You scratch your head and say, “Wow, we’re really doing something right here,’” he said.
Doing something right, indeed. In fact, the average door-to-balloon time at St. Luke’s Magic Valley Regional is 55 minutes. And that’s important, because when it comes to heart attacks, time is muscle. The longer a patient waits to have his arteries unblocked, the more of the heart muscle that dies.
A team effort
Having the fastest door-to-balloon team in the nation wasn’t Dr. Brown’s accomplishment alone. He shares the credit with a number of people, including paramedics, nurses, medical technicians, patient care coordinators and emergency room and intensive care unit staff.
“I’m really proud of the team we have here,” Brown said. “People should be knocking down our doors.”
When a Life Flight helicopter carrying a heart attack patient lands at the hospital, the team is there to meet them at the helipad.
When it comes speedy intervention, rural hospitals like St. Luke’s Magic Valley Regional do have some advantages over hospitals in large metropolitan areas, Brown said. Not having to fight big city traffic, the interventional cardiology treatment team can be at the hospital within 15 minutes.
The team has performed about 800 angioplasties since the hospital opened its interventional cardiology unit in September 2003, Brown said. It now does 200 to 250 angioplasties emergency and elective procedures a year.
But angioplasty isn’t for everybody. Local patients with a high risk of complications who could potentially need emergency surgery are flown to Boise. And while it used to be thought it was always good to open blocked arteries following a heart attack, a recent study funded by the National Heart, Lung and Blood Institute showed people who had balloon angioplasty to open an artery three to 28 days after their heart attacks fared no better than those given standard medicines to prevent a second attack. In fact, angioplasties in those cases could potentially do more harm, the study concluded.
Angioplasty and rural hospitals
It was long thought that rural hospitals without open heart surgical teams standing nearby shouldn’t tinker with hearts. Local cardiologists beg to differ. Brown, along with cardiologists Stanley Mogelson, Reed Harris, David Kemp and Critical Care Services Director Marlys Massey have published a paper in the Journal of Clinical Cardiology they say demonstrates that interventional cardiology procedures can be provided in a rural setting with results that are at least as good as the national average without untoward risk to the patient.
The paper, based on detailed records Brown kept on patients, showed that St. Luke’s Magic Valley Regional has the adequate patient volume to provide an interventional cardiology program even though it doesn’t have the volume to warrant a cardiac surgery program. In fact, the hospital recently brought a second interventional cardiologist on board, and the new hospital, set to break ground when weather permits, will have two interventional cardiology treatment rooms.
The paper also pointed out that patients get faster care than they would making the 50-minute helicopter ride to Boise or 90-minute helicopter ride to Salt Lake City.
And even if a patient suffered complications during an angioplasty in Twin Falls and needed surgery, that patient might spend less time on the helicopter to Boise than he would waiting for a surgeon and an operating room to become available at a Boise hospital.
Still, not all rural hospitals are candidates for interventional cardiology programs. How do you know if one is?
“You look at the community need,” Brown said. “Would the community be better off? It works here.”