In a spectacular turnabout, hospitals are treating
almost all major heart attack patients within the recommended 90 minutes of
arrival, a new study finds. Just five years ago, less than half of them got
their clogged arteries opened that fast.
The time it took to treat such patients plunged
from a median of 96 minutes in 2005 to only 64 minutes last year, researchers
found.
Some hospitals are moving at warp speed: Linda
Tisch was treated in a mere 16 minutes after she was stricken while visiting
relatives near Yale-New Haven Hospital in Connecticut this month. Emergency
responders called ahead to mobilize a team of heart specialists.
Once she arrived, "they had a brief
conversation and I went straight into the OR. My family was absolutely
flabbergasted," said Tisch, 58, who went home to Westerly, R.I., two days
later.
Tisch wasn't a fluke. The hospital took 26 minutes
on another case on Thursday.
"Americans who have heart attacks can now be
confident that they're going to be treated rapidly in virtually every hospital
of the country," said Yale cardiologist Dr. Harlan Krumholz. He led the
study, published online Monday by an American Heart Association journal,
Circulation.
What is remarkable about this improvement, Krumholz
said, is that it occurred without money incentives or threat of punishment.
Instead, the government and a host of private groups led research on how to
shorten treatment times and started campaigns to persuade hospitals that this
was the right thing to do.
"It's amazing and it's very gratifying. I'm
surprised that we were able to achieve that type of dramatic improvement"
so quickly, said Dr. John Brush, a cardiologist at Eastern Virginia Medical
School in Norfolk, Va., who helped the American College of Cardiology design
its campaign, which involved more than 1,000 hospitals.
Heart attacks are caused by clogged arteries that
prevent enough oxygen and blood from reaching the heart. Each year, about
250,000 people in the United States and more than 3 million worldwide suffer a
major one, where a main artery is completely blocked.
The best remedy is angioplasty, in which doctors
push a tube through an artery to the clog, inflate a tiny balloon to flatten
it, and place a mesh prop called a stent to keep the artery open.
The period from hospital arrival to angioplasty is
called "door-to-balloon" time, and guidelines say this should be 90
minutes or less. Any delay means more heart damage, and the risk of dying goes
up 42 percent if care is delayed even half an hour.
Not all hospitals have the capability to do
angioplasty around the clock, so part of the effort to speed care involved
setting rules for who has to be consulted before deciding to do the procedure.
The study involved more than 300,000 patients who
had an emergency angioplasty at hospitals that get Medicare reimbursements. The
researchers looked at records from 2005, just before campaigns to shorten
treatment times were launched, through September 2010.
Only 44 percent were treated in the recommended
time in 2005, but by last year it was 91 percent.
The National Heart, Lung and Blood Institute and
the Centers for Medicare and Medicaid Services paid for the study.
"It's not an exaggeration to say that care of
heart attacks in the United States has been transformed by this
improvement," said Dr. Christopher Granger, a Duke University Medical
Center cardiologist who led a Heart Association program to improve care.
"We've made very important progress but there
still is a lot of unfinished work in improving heart attack care," such as
what happens before people get to a hospital where angioplasty is done, he
said.
Patients also need to do their part, by knowing the
warning signs of a heart attack:
— Discomfort in the center of the chest lasting
more than a few minutes, or that goes away and comes back. It can feel like
pressure, squeezing, fullness or pain.
— Pain or discomfort in one or both arms, the back,
neck, jaw or stomach.
— Shortness of breath, which might include breaking
out in a cold sweat, or feelings of nausea or lightheadedness.
What to do is simple, doctors say: Call 911.
Copyright
2011 The Associated Press.
