June 15, 2007 — Heart attack patients receive lifesaving care up to an hour sooner after an Indiana hospital implements a novel protocol to rapidly activate their cardiac catheterization lab.
According to a report in the Journal of the American Heart Association, patients who arrived at the cardiac catheterization lab ("cath lab") sooner for artery-opening procedures had less heart damage and shorter hospital stay compared to the traditional protocol.
Patients in the study suffered ST-segment elevation myocardial infarction, or STEMI. The quicker a patient with this heart attack has the artery opened, the better the chances are for survival and less permanent damage to the heart.
Currently, the preferred treatment for this type of heart attack is emergency angioplasty, which is also called percutaneous coronary intervention (PCI). In this procedure, which is performed in a cath lab, a thin wire with a tiny balloon on the end is threaded through an artery to the blockage. When the balloon is inflated, it clears the blockage and restores blood flow to the heart.
Current American Heart Association/American College of Cardiology guidelines recommend a door-to-balloon time of 90 minutes or less for STEMI patients.
In this study, researchers made two fundamental changes to their STEMI treatment procedures. First, the emergency department physician who first sees the patient activated the cath lab as opposed to first having a cardiologist come see the patient.
The second part of the new protocol involved an in-house Emergency Heart Attack Response Team, consisting of an emergency department nurse, a critical care unit nurse and a chest pain unit nurse.
Upon activation of the cath lab by the emergency department physician, this team arrives in the emergency department and immediately moves the patient to the cath lab and prepared the patient for emergency PCI.
To analyze the protocol, researchers collected door-to-balloon time for 60 STEMI patients undergoing emergency PCI before the new system was implemented and compared them to 86 consecutive STEMI patients treated after the protocol was established.
Median door-to-balloon time decreased by a third overall - from 113.5 minutes to 75.5 minutes. It dropped from 83.5 minutes to 64.5 minutes during regular hours and from 123.5 minutes to 77.5 minutes during off-hours. Treatment within 90 minutes increased from 28 percent to 71 percent.
In addition to improved door-to-balloon time, the study revealed that the size of the heart attack suffered by patients decreased by 40 percent. Faster treatment also resulted in the average hospital stay being two days shorter (falling from five days to three days), and the average hospital costs per admission declined by nearly $10,000, from $26,826 to $18,280.
For more information: www.americanheart.org