Tuesday, June 19, 2007

Faster Heart Attack Care Saving Lives

After an Indiana hospital introduced a new protocol to get heart attack patients into the cardiac catheterization lab more quickly for artery-opening procedures, patients received lifesaving care up to an hour sooner than before and suffered less heart damage, researchers report.

They also had shorter hospital stays, according to a study published in the June 11 issue of Circulation.

The study included patients with a type of heart attack called ST-segment elevation myocardial infarction (STEMI), which is caused by a completely blocked artery. The sooner the artery can be opened, the lower the risk of death or permanent heart damage.

Emergency angioplasty
-- also called percutaneous coronary intervention (PCI) -- is the preferred treatment for this kind of heart attack, according to background information in the study.

"The benefit of emergency PCI depends on how quickly a patient receives treatment. However, only about a third of patients in the United States receive treatment within the recommended 90 minutes," study lead author Dr. Umesh N. Khot, a cardiologist at Indiana Heart Physicians/St. Francis Heart Center in Indianapolis, said in a prepared statement.

He and his colleagues made two major changes to the hospital's STEMI treatment protocol. First, the emergency department doctor who first sees the heart attack patient now immediately activates the cath lab. Next, an Emergency Heart Attack Response Team -- which includes an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse -- moves the patient to the cath lab and prepares the patient for emergency PCI.

"Traditionally, most hospitals require the emergency department physician to contact a cardiologist who comes to see the patient. Only after the cardiologist sees the patient is the cath lab activated. Waiting for the cardiologist before activating the cath lab delays care without any clear benefit," Khot said.

Then, "patients have to wait in the emergency department for the catheterization team members to prepare the cath lab or arrive from home during nights and weekends."

Khot and his colleagues compared 60 STEMI patients who had emergency PCI before the new protocol was implemented and 86 STEMI patients treated after the new protocol was in place.

The median time it took for a patient to be treated after arriving at the hospital decreased by a third -- from 83.5 minutes to 64.5 minutes during regular hours and from 123.5 minutes to 77.5 minutes in off-hours. The proportion of patients who received emergency PCI within 90 minutes increased from 28 percent to 71 percent, the research team say.
Source: Healthday