Life-saving transfer of heart patients lagging

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A quick transfer from one hospital to another with more sophisticated facilities can be a lifesaver for heart attack patients—but quick transfers are a rarity in the U.S., researchers said Monday.

In a nationwide study published in the Archives of Internal Medicine, they found nine out of ten patients end up waiting longer than recommended before being transferred to a hospital that can provide optimal care.

For many heart attacks, optimal care means clearing the blocked coronary artery that’s cutting off blood supply to the heart, then placing a small tube called a stent to keep the artery open.

"Opening the artery quickly results in much better survival for patients,” said Dr. Harlan Krumholz of Yale School of Medicine, who worked on the study.

“It’s really the sooner, the better,” he told Reuters Health. “The longer the heart is deprived of blood flow the more damage is done.”

Hospitals strive to get patients treated within 90 minutes from the moment they roll in the door.

But less than a quarter of U.S. hospitals are equipped to perform stenting around the clock, so many choose to send patients elsewhere. To make sure the procedure is still worthwhile, the national goal is to have patients transferred within 30 minutes.

Just one in ten patients left the first hospital within that time frame according to the new study, which is based on 2009 data from nearly 14,000 patients at 1,034 hospitals.

The patients had a type of heart attack known as STEMI, which strikes some 250,000 Americans every year—about a fifth of all heart attack patients nationwide.

In more than half the cases, Krumholz and his colleagues found hospitals took longer than one hour to transfer patients. And almost a third took 90 minutes or more.

“What we are finding is really long delays,” Krumholz told Reuters Health. “Some people are being transferred out even after 90 minutes or two hours. There is no way those people are going to get timely treatment.”

The fastest state was New Hampshire, which transferred half its patients within 43 minutes or less, followed by Kansas and Minnesota.

The slowest was Wyoming, which took 207 minutes or more for half its patients to be transferred, followed by Hawaii and West Virginia.

The findings, based on data from the Centers for Medicare & Medicaid Services, square with other research from this year suggesting that as many as 50,000 Americans have stents placed more than a day after their heart attack, at which point it is no longer helpful.

Stenting procedures cost the U.S. about $12 billion every year and carry small risks of complications like major bleeding or tears in the heart.

A study published along with the Yale report describes how one California hospital changed its poor transfer results by establishing a so-called cardiac catheterization laboratory, or cath lab, enabling it to perform stenting around the clock.

Although the hospital is located within a few miles of four other clinics that could do the procedure, it used to take more than 200 minutes for the typical patient to get a stent.

That dropped to 84 minutes with the new cath lab, Dr. Eric A. Secemsky of San Francisco General Hospital and colleagues report.

But cath labs are expensive, making them a luxury not all hospitals can afford, Dr. Rita Redberg of the University of California, San Francisco, notes in an editorial.

Because years of efforts to cut transfer times have been largely disappointing, she adds, “it is time to consider other strategies.”

Redberg, who is also the editor of the Archives of Internal Medicine, suggests patients who can’t be taken directly to a hospital with a cath lab should get clot-buster drugs in the ambulance or as soon as they arrive at the hospital.

While the drugs aren’t quite as effective as a prompt heart procedure, the gap disappears about one hour after the heart attack, she notes—meaning that for the many Americans who are transferred late, they might actually save lives.

SOURCE:  Archives of Internal Medicine, November 28, 2011.

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