Regional coordination cuts time to heart attack treatment
August 2, 2016
NEW YORK – By coordinating emergency resources, an experimental U.S. program got more heart attack patients treated promptly, researchers say.
Before the program started, 50 percent of people who showed up at hospitals got artery-opening therapy within the recommended window of time. The percentage increased to 55 percent after the program, researchers report.
"It’s absolutely clear that to save the lives of people having heart attacks we have to open the artery quickly," said senior author Dr. Christopher Granger, of Duke University Medical Center in Durham. "We can probably reduce mortality by 60 percent."
The American Heart Association (AHA) recommends that patients with heart attacks caused by a completely blocked artery - known as STEMIs - undergo a procedure to unclog their artery within 90 minutes of a paramedic's arrival, or within 120 minutes if the nearest hospital can't perform the procedure and the patient needs to be transferred to a hospital that can.
The procedure is known as percutaneous coronary intervention, or PCI. A small tube is threaded through the blood vessels to reach and clear the blockage.
Yet as Granger and his colleagues note in the journal Circulation, fewer than half of Americans having STEMIs are treated with PCI in that time frame.
"Even though the principles are clear, how one does that is highly dependent on the coordination of emergency medical services and the network of hospitals in the region," Granger told Reuters Health.
For the new study, the researchers worked to coordinate care between 484 hospitals and 1,253 emergency medical services agencies in 16 regions across the U.S. in 2012 and 2013.
There was no one-size-fits-all solution for the regions, but the researchers brought together key stakeholders from the local healthcare systems to develop protocols and plans to get more people to early treatment.
Lead author Dr. James Jollis, also of Duke University, described one such protocol: EMS technicians may be able to diagnose a heart attack in the field, notify a hospital capable of clearing the blockage and take the patient directly to the operating room without stopping at the ER.
During the study, 23,809 people in those regions had heart attacks and were treated at hospitals that could perform PCI - including 11,765 who were brought directly to those hospitals by EMS ambulances, 6,502 who brought themselves to those hospitals and 5,542 who were transferred from another hospital.
The percentage of people meeting the AHA guidelines increased from 50 percent to 55 percent when people came directly to those hospitals, either by ambulance or by themselves.
Similarly, the percentage of transferred patients who met the guidelines rose from 44 percent to 48 percent.
The researchers also note that death rates for heart attack patients at hospitals participating in the program fell slightly, while the national average remained unchanged.
"In the long run, (this program) should be everywhere in the U.S.," Jollis told Reuters Health. "Every single patient should be treated according to these protocols."
The program is part of the AHA's larger Mission: Lifeline project, which aims to increase emergency response times for people having heart attacks.
Dr. Umesh Khot, vice-chairman of cardiovascular medicine at the Cleveland Clinic in Ohio, said the results may be modest, but what the researchers undertook was monumental.
"What they tried to do in this paper was move the Titanic," said Khot, who was not involved with the new study. "This was a very ambitious project."
He called the results encouraging and said patients too play an important role in getting early treatment for their heart attacks.
"If they don’t trigger the system by calling 911, then all of this can’t benefit them," he said.