Coordinated care means faster treatment for rural heart attack patients

Heart attack patients as far as 150 miles away from a 24-hour emergency heart care center were able to receive treatment for blocked arteries within or faster than current recommended time frames, according to a study published in Circulation: Journal of the American Heart Association.

“A heart attack is a true medical emergency, where every 20 to 30 minute delay could impact whether your patient lives or dies,” said Henry Ting, M.D., lead author of the study and a cardiologist at Mayo Clinic in Rochester, Minn., who coordinates quality improvement efforts for cardiology services.

Saint Marys Hospital in Rochester is part of the Mayo Clinic. It houses a 24-hour, seven-day-a-week cardiac catheterization lab, which means the facility is fully equipped to handle emergency angioplasty, also known as percutaneous coronary intervention (PCI), to open blocked coronary arteries in the quickest way possible. Twenty-eight hospitals across three states in the region don’t have this capability, so heart attack patients are sent to Saint Marys Hospital for treatment.

Ting and his colleagues implemented and evaluated a protocol, called the “Fast Track”, for patients of Saint Marys Hospital or for those of 28 surrounding hospitals in the region as far as 150 miles away who were transferred to Saint Marys Hospital in a cardiac emergency.

“We mapped the processes of care and eliminated redundant steps that added no value from the perspective of the heart attack patient,” Ting said. “From there, we implemented and evaluated the regional system of care, striving to coordinate and integrate how to deliver the best and fastest reperfusion therapy to open up an occluded coronary artery.”

A major heart attack is when a complete blockage occurs in a coronary artery. This is called an ST-elevation myocardial infarction (STEMI). Treatment for STEMI patients includes either emergency angioplasty (a tiny wire is inserted into the blocked artery and a balloon and/or stent is used to re-open the coronary artery) or injection of a clot-busting drug.

American Heart Association guidelines recommend that angioplasty be given within 90 minutes of a patient’s arrival at the hospital, and clot-busting drug treatment within 30 minutes. The time between hospital arrival and treatment is called door-to-balloon time with angioplasty or door-to-needle time with drugs. A shorter door-to-treatment time increases a patient’s chance of survival.

The study showed that Mayo Clinic treated 597 consecutive patients from May 2004 to December 2006. There were three groups of study subjects. Group A included 258 patients who arrived at Saint Marys Hospital and were treated with primary angioplasty. Group B was made up of 105 patients who came to a regional hospital more than three hours after their symptoms began and were transferred to Saint Marys Hospital and treated with primary angioplasty. Group C included 131 patients who came to a regional hospital less than three hours after their symptoms began and were treated with a clot-busting drug and then transferred to Saint Marys Hospital.