Saving Time, Saving Lives

Nov.13, 2006 — -- An estimated 1,000 lives could be saved each year if hospitals could treat heart attack patients a bit more quickly.

Starting today, hundreds of hospitals across the country have pledged to step up and speed up.

Hospitals are joining an ambitious nationwide effort to give faster emergency room care to patients during and immediately after a heart attack.

The campaign, announced by the two large heart groups, the American Heart Association and the American College of Cardiology, seeks to get hospitals to speed up what is called "door to balloon time" (D2B) -- the time it takes from when the patient arrives at the emergency room to the time the patient has their blocked artery opened with an angioplasty balloon.

The campaign, the D2B Alliance, was announced at an American Heart Association meeting in Chicago. The doctors who launched it expect to see life-saving results within months.

Tracking the Minutes

Most heart attack patients do not get to a hospital quickly enough. But even when they do, precious minutes are often wasted.

"Every hospital in the country, virtually, has this problem," says Dr. Harlan Krumholz of the Yale University School of Medicine in New Haven, Conn.

"That is, they haven't specifically codified how they're going to treat the patients who come in with a heart attack and make it seamless so that they're treated in rapid fashion."

Heart attack patients should be treated within 90 minutes of arriving at a hospital, or the risk of dying increases dramatically. But studies show that two-thirds of heart attack patients end up waiting longer.

The problem isn't in the emergency room. If a patient arrives at almost any hospital complaining of severe chest pain, doctors will come running. What takes time is getting the actual treatment, which for most patients is angioplasty.

Experts seem to know what the problem is. So, why hasn't anybody fixed it?

One expert, Dr. Steve Nissen, president of the American College of Cardiology, puts it bluntly: "Many hospitals in America don't know what they are doing."

Doctors Working Together

Researchers say doctors in the emergency room and cardiologists performing the angioplasty are often not working together efficiently.

"There is often a delay in terms of how much discussion needs to take place," says Krumholz.

"How difficult is it to contact the key people who need to come in?"

So, starting today, more than 200 hospitals are implementing a streamlined system that makes it easier for doctors to give needed treatment to patients when they need it most.

Steps to Save Lives

The steps involved are relatively simple. Under the new system, for example, emergency room doctors are authorized to prepare the treatment room while waiting for the cardiologist to arrive.

That alone would save eight minutes.

Also, having the hospital operator page the angioplasty team with one call instead of having the E.R. staff trying to hunt the team down saves, on average, another 13 minutes.

Requiring an angioplasty doctor to be no more than 20 minutes away would save 19 minutes.

Saving a life would, obviously, be priceless. And these life-saving measures seem simple. "This is common sense stuff," says Dr. Gabriel Wilson of St. Luke's Roosevelt Hospital in New York City.

"Common sense stuff that almost any hospital could use without much added cost."

One hospital that's been using the new approach cut heart attack deaths by 36 percent. Major medical groups and government agencies are standing by with their endorsements.

Doctors who are a part of the campaign are hoping for real, practice-changing results. Krumholz predicts the changes will save lives, and he is hopeful the campaign will have a big impact.

"We're not going to be happy unless this changes practice in the next nine months," he says.