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Study finds improved heart attack care

Medicine@Yale, 2010 - Jan Feb


Using new guidelines, hospitals are unblocking arteries more quickly, and improving patients’ outcomes

Patients with heart disease have benefitted enormously from advances in cardiology over the last few decades, including cholesterol-lowering statin drugs and better blood pressure medications. And if a heart attack should occur, percutaneous coronary intervention (PCI; more commonly known as balloon angioplasty) can be a lifesaver, opening up blocked arteries to restore blood flow to the heart.

But with PCI, time is of the essence. In 2006, in order to minimize lasting damage to heart cells from oxygen deprivation, the American College of Cardiology and 38 partner organizations launched a national campaign known as the D2B Alliance. To shorten “door-to-balloon” (D2B) times—the time from when a patient enters the hospital to the point when blood flow is restored to the heart by opening a blockage with angioplasty—the alliance set a goal of 75 percent of patients receiving this life-saving heart attack care within 90 minutes of hospital arrival.

In 2005, less than half of hospitals studied met those guidelines for D2B times. But in a study of the most recent data from the National Cardiovascular Data Registry (NCDR) published by a Yale-led team in the December 15, 2009 issue of the Journal of the American College of Cardiology, more than 80 percent of hospitals met the guidelines.

The study team surveyed D2B times in 831 hospitals participating in the NCDR’s CathPCI Registry from April 1, 2005 to March 31, 2008. The survey showed marked reductions in unnecessary delays in treatment and widespread adoption of recommended strategies to improve care. The improvement was seen not just in select hospitals or certain states, but across the nation.

“The key is to have a leader and a team devoted to a single goal and to be persistent, even in the face of setbacks,” says senior author Elizabeth H. Bradley, Ph.D., professor of public health at the Yale School of Public Health and associate clinical professor of nursing. “This campaign has changed the way heart attack care is delivered—for the benefit of patients.”

Some examples of strategies to reduce D2B times include having emergency department staff able to activate the catheterization laboratory with a single call, taking steps to ensure that a catheterization team can be in the lab within 20–30 minutes of being paged, and promptly reporting data on D2B times to staff.

Bradley’s co-author Harlan M. Krumholz, M.D., the Harold H. Hines Jr. Professor of Medicine and Public Health, said patients are now being treated so rapidly that in some cases the heart attack is aborted, damage is avoided, and patients rapidly experience a full recovery. “This remarkable leap in performance is a tribute to the nation’s interventional cardiologists and other healthcare professionals who quickly adopted effective systems that were developed by NIH-sponsored research,” he says.

“Most of what we read about in health care reform is about health care financing,” Bradley adds. “This effort shows that the way care is organized can have tremendous impact, and with relatively little added resources.”