A national push to avert delays in heart attack treatment has sharply increased the percentage of people who get prompt care, a study shows.
Heart attacks occur when a blood clot cuts off the heart's blood supply. Doctors have known for years that a heart deprived of blood soon begins to die.
The most effective treatment, angioplasty, involves inflating a narrow balloon in the clogged blood vessel to clear it. Yet for years, fewer than half of all patients with severe heart attacks were treated within the 90-minute window known to save lives.
Many patients were stalled in the emergency room waiting for more tests, for an exam by a specialist or for doctors who are skilled at clearing clogged arteries, senior author Harlan Krumholz of Yale University said Wednesday.
In 2006, the American College of Cardiology and 38 other groups launched the "D2B" campaign to improve "door-to-balloon" times.
A study of 87,000 patients at 861 hospitals from 2005 to 2008 in the Journal of the American College of Cardiology shows steady improvement. Nearly 80% now get treated within 90 minutes. "We're trying to drive down the time so far that we can actually avoid all damage," he says. "It's as if somebody never had a heart attack."
Doctors at the Mayo Clinic now routinely treat patients within 30 minutes and are working on a study they hope will show a reduction in death rates as a result of improved treatment, says Henry Ting, the clinic's director of cardiology quality.
So far, evidence is lacking, says John Rumsfeld of Denver VA Medical Center and the cardiology college. "Despite the large national changes in door-to-balloon times, it's not yet clear that translates into better patient outcomes," he says. Nevertheless, he says, the study shows the D2B campaign, adopted by 1,000 of 1,400 hospitals that can perform emergency angioplasty, achieved a major milestone: a coordinated national effort to improve care.
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