U.S. hospi­tals set mark for fast heart at­tack care

Austin American-Statesman - - MORE OF TODAY'S TOP NEWS - By Mar­i­lynn Ma­chione

There’s never been a bet­ter time to be treated for a heart at­tack. U.S. hospi­tals have set a record for how quickly they open blocked ar­ter­ies, av­er­ag­ing un­der one hour for the first time since these re­sults have been tracked.

More than 93 percent of pa­tients now have their ar­ter­ies opened within the rec­om­mended 90 min­utes of ar­rival.

“Things have def­i­nitely im­proved” from a decade ago, when less than half of heart at­tack pa­tients were treated that fast, said Dr. Fred Ma­soudi, a Univer­sity of Colorado car­di­ol­o­gist who led a re­cent re­port ex­am­in­ing re­sponse times.

It’s based on records from about 85 percent of U.S. hospi­tals that do the artery pro­ce­dure, an­gio­plasty. Through a blood ves­sel in the groin or an arm, doc­tors guide a tube to the block­age caus­ing the heart at­tack. They in­flate a tiny bal­loon to flat­ten the clog, and leave be­hind a mesh tube called a stent to prop the artery open.

The sooner blood flow is re­stored, the less chance of per­ma­nent dam­age.

“It’s one of the few things in medicine where time, lit­er­ally sec­onds, is of the essence. It’s where the phrase ‘time is mus­cle’ comes from,” said Dr. Ajay Kir­tane, di­rec­tor of the lab that per­forms an­gio­plas­ties at New York-Pres­by­te­rian/Columbia Univer­sity Med­i­cal Cen­ter.

The risk of dy­ing goes up 42 percent if care is de­layed even a half-hour beyond the 90 min­utes that U.S. guide­lines say pa­tients should be treated af­ter ar­rival.

In 2005, this “door-to-bal­loon” time av­er­aged a dis­mal 96 min­utes, and the Amer­i­can Col­lege of Car­di­ol­ogy led a drive to get hospi­tals to im­prove. The re­port shows it plunged to 59 min­utes in 2014.

But all that speed by the hos­pi­tal won’t do much good un­less pa­tients act fast, too, and call 911 if they think they might be hav­ing a heart at­tack.

The warn­ing signs:

■ 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.

The re­port shows that fewer peo­ple are get­ting pro­ce­dures in­ap­pro­pri­ately. In 2014, about one third of an­gio­plas­ties were elec­tive, for non-emer­gency sit­u­a­tions. Just over half were deemed to be done for clearly ap­pro­pri­ate rea­sons.

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