Speeding up initial treatment means more victims survive heart attacks

Nov 14 2006

According to a newly published study, far more heart attack victims would survive if hospitals applied some simple, timesaving strategies.

Researchers in the U.S. say most heart attack patients stand a better chance of survival if they get artery-clearing treatments within 90 minutes of the attack, however it seems that in reality as few as 20 percent of U.S. hospitals are able to provide that level of prompt treatment.

Dr. Harlan Krumholz a professor of medicine at Yale University School of Medicine says it is known that faster times are associated with better outcomes but currently only around a third of hospitals are able to treat even half of their patients in 90 minutes or less.

Dr. Krumholz conducted a study, which evaluated 28 strategies for speeding the interval between arrival at 365 U.S. hospitals and the time of treatment for patients with a common type of heart attack called ST-elevation myocardial infarction.

They 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.

They researchers found that simple steps, such as giving emergency department staff the authority to call in specialists without first consulting a cardiologist, could significantly shorten treatment times.

The team identified six strategies which could speed up the process and improve outcomes; they are:-

• 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.

• The biggest time saver would be to require heart catheterization specialists to arrive at the hospital within 20 minutes of being paged; the current standard time is 30 minutes.

As a direct result of the study's findings, the American Heart Association and the American College of Cardiology have started a nationwide campaign to improve treatment times.

Dr. Steven Nissen, president of the American College of Cardiology says at present 35% of heart attack patients in America have an artery opened in 90 minutes or less and the goal now is 75 percent.

Dr. Krumholz says 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, and 200 hospitals have already signed up, but the goal is to make this type of care standard in hospitals nationwide.

The study was presented at the annual scientific meeting of the American Heart Association and is published in the New England Journal of Medicine.