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

The Denver Post - - FRONT PAGE - By Mar­i­lynn Mar­chione

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 YorkPres­by­te­rian/Columbia Univer­sity Med­i­cal Cen­ter.

The risk of dy­ing goes up 42 percent if care is de­layed even half an 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.

It was only 24 min­utes for Ge­orge Smith at UConn John Dempsey Hos­pi­tal in Farm­ing­ton, Conn. The 82-yearold woke up March 31 with in­tense jaw pain, the same kind he had dur­ing a heart at­tack two years ago. His wife called 911. An am­bu­lance whisked him to the emer­gency room, and “they were all wait­ing for me” at the door, he said.

An hour later he was sit­ting up in

bed with a new stent.

“I was amazed,” he said. “Such a bless­ing.”

One rea­son UConn is so fast — its me­dian door-to-bal­loon time was 56 min­utes last year, and only 39 min­utes dur­ing one re­cent quar­ter — is the work it has done to make its emer­gency re­spon­ders part of the car­diac care team, said the hos­pi­tal’s EMS co­or­di­na­tor, Peter Can­ning.

“We used our paramedics to ex­tend our hos­pi­tal into the pa­tient’s home,” where they do an ex­ten­sive elec­tro­car­dio­gram of the heart­beat and call re­sults ahead to the hos­pi­tal to get the an­gio­plasty room ready, he said. “Call­ing from 25 min­utes out in­stead of five min­utes out can be a sav­ings of 20 min­utes of heart mus­cle.”

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.

“For women, the symp­toms may not be the same. It may not be the typ­i­cal chest pain” but rather ab­dom­i­nal pain, nau­sea or un­usual tired­ness, said Dr. An­napoorna Kini, a car­di­ol­o­gist at Mount Si­nai Hos­pi­tal in New York City.

What to do?

“Get med­i­cal help,” she said. “It’s bet­ter to worry af­ter” about whether it was re­ally a stom­ach prob­lem rather than a heart at­tack.

An­gio­plasty also is done for non­emer­gency con­di­tions, to treat chronic chest pain caused by ar­ter­ies that are clogged but not se­verely blocked, and its use in that set­ting is more ques­tion­able. Of­ten medicines and other things can be tried first, and an­gio­plasty can be avoided or de­layed.

The re­port shows that fewer peo­ple are get­ting these pro­ce­dures in­ap­pro­pri­ately. In 2014, about one-third of an­gio­plas­ties were elec­tive, for non­emer­gency sit­u­a­tions. Just over half were deemed to be done for clearly ap­pro­pri­ate rea­sons, and another one-third were clas­si­fied “may be ap­pro­pri­ate” un­der guide­lines from the car­di­ol­ogy col­lege and oth­ers.

About 14 percent were deemed “rarely ap­pro­pri­ate” — less than other re­search has found in the past.

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