University of Kentucky's fast-track protocol reduces risk of death in heart attack patients

Jan 23 2010

Heart attack patients won't go to the emergency room as part of a new University of Kentucky plan designed to reduce those patients' risk of dying by nearly 8 percent for every half hour shaved off the time between the ambulance and treatment at the hospital.

In most cases, heart attack sufferers go straight to the cardiac catheterization lab in the UK Gill Heart Institute, where a specialized response team waits to break through the life-threatening blood clot that is causing the attack.

As part of the fast-track protocol, when responding to a possible heart attack, specially trained paramedics administer a painless test called an electrocardiogram, or EKG (also called ECG), which can help detect a heart attack.

If the test and other warning signs indicate the patient is in the midst of a heart attack, with the patient's consent the paramedics activate the cardiac catheterization team on their way to the UK Gill Heart Institute. Once the patient arrives, the cardiac catheterization team, led by a physician who specializes in treating heart disease, assesses the patient and the EKG to determine whether they should perform an emergency angioplasty, a minimally-invasive procedure to open blocked blood vessels. Patients who are not believed to be having a heart attack are taken to the emergency department for further assessment.

UK cardiologists are conducting ongoing training with emergency medical service providers in a one-hour flight radius of the medical center. American College of Cardiology guidelines recommend treating patients with angioplasty within 90 minutes of contact with a healthcare facility for a suspected heart attack. For every 30 minutes saved, the patient's risk of dying is reduced by 7.5 percent. So far, UK has reduced the time to treatment by about 35 minutes.

The new protocol—believed to be the first for an academic medical center—was established in the wake of a study of 10 centers that utilized pre-activation of cardiac catheterization teams en route to the emergency department. The study, published earlier this year in the Journal of the American College of Cardiology, showed that more than 86 percent of those patients were able to receive a potentially life-saving cardiac catheterization within the recommended time.

"We hope to have an even higher or 100 percent success rate by bypassing the emergency department and taking the patient immediately to the catheterization laboratory for treatment," said Dr. Debabrata Mukherjee, director of cardiovascular catheterization services at UK. "The goal is to treat the patient as quickly as possible and give them the best chance of a good recovery and return to normal life."

Exceptions to the protocol at UK include car accident victims who may be having a heart attack. Those patients must be assessed first by a trauma team in the emergency department.

Experts in cardiovascular medicine, emergency medicine and trauma care at UK helped develop the plan. Amy Herrington, the patient care manager in the UK Chandler Hospital Emergency Department, said education of both patients and first responders is a big part of the new system.

"We have created a program that not only involves pre-hospital activation but a collaboration with pre-hospital providers," Herrington said. "Our approach to improve outcomes for all patients in the Commonwealth centers around education, early activation and constant quality improvement driven by all who interact with the system. We have created a transparent system so the patient receives the best possible care."

SOURCE University of Kentucky