Simple steps can speed heart attack care

If U.S. hospitals implemented some simple, timesaving strategies, heart attacks patients could get quicker treatment and would be more likely to survive, according to a study released on Monday.

Heart attack patients have a better chance of survival if they get artery-clearing treatments within 90 minutes of the attack, but only about 20 percent of U.S. hospitals are able to meet that standard.

"We know that faster times are associated with better outcomes," said study author Dr. Harlan Krumholz of the Yale University School of Medicine.

"Right now, only about one third of the hospitals is able to treat even half of their patients in 90 minutes or less," he said at the annual scientific meeting of the American Heart Association.

In the study, which was published online in the New England Journal of Medicine, researchers evaluated 28 strategies for speeding the interval between arrival at the hospital and the time of treatment for patients with a common type of heart attack called ST-elevation myocardial infarction.

They found that simple steps, such as giving emergency department staff the authority to call in specialists without first consulting a cardiologist, could significantly shorten treatment times.

Researchers said the biggest timesaver would be to require heart catheterization specialists to arrive at the hospital within 20 minutes of being paged. The current standard is 30 minutes.

That change could save 19.3 minutes for patients waiting to receive a life-saving angioplasty, in which a balloon is inflated in the artery to restore blood flow to the heart.

The study also recommended: placing a single call to a central operator who alerts the catheterization lab, saving 13.8 minutes; having the emergency department alert the lab while the patient is transported to the hospital, saving 15.4 minutes; and always having an attending cardiologist on site, saving 14.6 minutes.

Using the study's findings, the American Heart Association and the American College of Cardiology have started a nationwide campaign to improve treatment times.

"Thirty-five percent of patients in America have an artery opened in 90 minutes or less. Our goal is 75 percent," said Dr. Steven Nissen, president of the American College of Cardiology.

"Everybody we've asked to do this has said this is the right thing to do. Payers want it. Government wants it. Hospitals want it. Physicians want it."

Krumholz said several hospital chains have signed on to the effort, including HCA Inc., Tenet Healthcare Corp., Kaiser Permanente, Premier Inc. and the Veterans Administration.

He said the biggest barrier to change is inertia and believes the study will give hospitals the tools they need to change.