Heart Attack Treatment Speeds Up Nationwide

A nationwide program to get faster treatment for people with the most severe kind of heart attack has dramatically reduced the time between hospital arrival and lifesaving angioplasty.

More than three quarters of people with STEMI heart attacks—so called because of the electrocardiogram pattern that shows major blockage of a heart artery—were receiving artery-opening angioplasty within 90 minutes of reaching a hospital in 2008, said a report released online in the Journal of the American College of Cardiology.

Before the campaign began, in 2005, only half of those patients met the 90-minute deadline recommended for emergency angioplasty.

"It is a remarkable leap in performance, a tangible improvement in how people are being treated around the country," says Harlan M. Krumholz, MD, a professor of medicine at Yale University School of Medicine and an author of the journal report.

When the American College of Cardiology and 38 partner organizations set up what is called the Door-to-Balloon (D2B) Alliance, there were doubts that it could succeed, Krumholz says. The name is based on the angioplasty procedure, in which a thin, balloon-tipped catheter is threaded into a blocked heart artery, and the balloon is expanded to restore blood flow.

The report on 831 hospitals showed the 90-minute door-to-balloon deadline for STEMI heart attacks being met in 52.5% of cases in 2005. That number increased to 76.4% of cases in 2008.

And the improvement has continued, said the American College of Cardiology. Its most recent data, from June 2009, shows 81.7% of patients getting 90-minute door-to-balloon time. Also, the average time for start of angioplasty decreased from 121 minutes in 2005 to 80 minutes in 2009.

Most of the changes prompted by the program were simple: Having ambulance attendants call the hospital to alert them that a heart attack victim was on the way, alerting the catheterization laboratory where angioplasty is done and the interventional cardiologists who do the procedure to be ready to go to work, and getting the patient to the catheter laboratory as quickly as possible.

But a key ingredient was a change in the mindset of the hospital personnel dealing with heart attacks, Krumholz says. "The important thing is that everyone felt they were working hard and fast before this. But the numbers showed they weren't. Then people came together and reworked the process by which these procedures were done."

— Source: Brigham and Women's Hospital