A new study that showed reducing “door-to-balloon” times in hospitals did not improve survival rates for patients with severe heart attacks, also emphasizes the need to save time between the start of severe heart attack symptoms and patients’ arrival at the hospital, said Gray Ellrodt, M.D., national spokesperson for the American Heart Association and chief of medicine at Berkshire Medical Center in Pittsfield, Mass.
A recent New England Journal of Medicine study reviewed the records of about 97,000 patients with severe heart attacks who were admitted to 515 hospitals between 2005 and 2009.
Researchers found that although many hospitals improved the time between when patients arrive at the emergency room and undergo primary percutaneous coronary intervention – or door-to-balloon times – there was not a similar improvement in survival rate.
Percutaneous Coronary Intervention treats patients with ST-elevation myocardial infarction, a heart attack that occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or stopped. Also known as angioplasty, the procedure uses a balloon to clear the blockages and restores normal blood flow to the heart muscle.
“It’s encouraging that hospitals universally have responded to the initiatives to decrease door-to-balloon times and have achieved maximal benefit,” said Dr. Ellrodt, also chair of the American Heart Association’s Mission: Lifeline advisory working group. “Now, we must pivot and increase focus on pre-hospital triage, treatment, and transport.”
Forty percent of patients with severe heart attack don’t call 9-1-1, causing significant treatment delays.
“There is great opportunity for earlier EMS activation and utilization, more pre-hospital diagnosis, and emergency department bypass for low-risk patients,” said Dr. Ellrodt. “Most importantly, we need to greatly improve the ECG interpretation skills by EMS and the emergency department.”
The American Heart Association’s Mission: Lifeline program encourages patients, first responders and hospitals to streamline care for severe heart attacks by:
- Increasing patients’ awareness of symptoms and the need to call 9-1-1;
- Reducing the amount of time between first symptoms and treatment;
- Improving EMS recognition and diagnosis of severe heart attacks;
- Equipping and training EMS to use electrocardiograms en route to the hospital;
- Activating the cardiac catheterization lab quickly and appropriately;
- Shortening the transfer time between medical facilities.
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