Many Hospitals Do Not Meet Angioplasty Guidelines
Only about one-third of hospitals perform balloon angioplasties on heart attack patients with blocked arteries in time to meet medical guidelines, according to a study released Monday at a meeting of the American Heart Association and published on the New England Journal of Medicine Web site, USA Today reports.
For the study, sponsored by the National Heart, Lung and Blood Institute, Harlan Krumholz of Yale University and colleagues surveyed 365 hospitals to determine the average time that they took to perform balloon angioplasties after heart attack patients arrived.
Balloon angioplasties, in which physicians inflate a small balloon to unblock arteries, reduce risk for death among heart attack patients by 40% when performed within 90 minutes of their arrival to the hospital, according to guidelines from the AHA and the American College of Cardiology.
According to the study, 35% of hospitals performed balloon angioplasties in 90 or fewer minutes on average, and 48% performed the procedure in between 91 and 120 minutes on average. About 13% of hospitals performed balloon angioplasties in between 121 and 150 minutes on average, and 4% performed the procedure in more than 150 minutes on average, the study found.
Krumholz said, "Even among the better hospitals, only a few hospitals routinely meet the recommended guidelines." He estimated that adherence to the guidelines at all hospitals would save about 1,000 lives annually.
The study recommends that paramedics perform electrocardiograms on heart attack patients in transit to the hospital to allow emergency department teams to inform angioplasty teams without additional consultation. In addition, the study recommends that page operators have the ability to reach all members of angioplasty teams and that all members have the ability to reach hospitals within 20 minutes.
The study also recommends that hospitals provide feedback to angioplasty and ED teams on heart attack cases.
The study will help launch a new campaign called D2B, for door-to-balloon, which will seek to help hospitals improve emergency care for heart attack patients.
United Healthcare, Premier Health Care Services, Aetna, WellPoint and Blue Cross and Blue Shield have agreed to participate in the campaign (Sternberg, USA Today, 11/13).
According to the AP/Hartford Courant, the campaign is the "the most ambitious project ever undertaken to give faster emergency room care to people suffering major heart attacks."
John Brush, a Virginia heart specialist who helped ACC develop the campaign, said, "There's a very, very large opportunity here to improve patient care" (Marchione, AP/Hartford Courant, 11/13).
Designated hospitals in Orange County can perform angioplasty on heart attack patients within 69 minutes of their arrival at the hospital, faster than the time limit cited in the study, the Orange County Register reports.
The county Emergency Medical Services department has designated 12 hospitals in the county as cardiac receiving centers. To receive the designation, hospitals must demonstrate that they can perform angioplasty within 90 minutes of a patient arriving at the hospital and have a cardiologist and cardiac surgeon on staff. In addition, the hospitals must have a cardiac catheterization lab available 24-hours a day (Bernhard, Orange County Register, 11/14).
In related news, only one in five hospitals perform balloon angioplasties on heart attack patients with blocked arteries in time to meet medical guidelines, according to a study released Monday at the AHA meeting and published on the NEJM Web site, the Detroit Free Press reports.
For the report, University of Michigan researchers Mauro Moscucci and Kim Eagle collected data from 22 Michigan hospitals that participated in a Cardiac Consortium project funded by Blue Cross and Blue Shield of Michigan and affiliate Blue Care Network.
According to the study, 2.2% of patients who received angioplasties within 90 minutes of their arrival to the hospital died, compared with 5% of those who waited longer. The study also found that 3.5% of women who received angioplasties within 90 minutes died, compared with 7.6% of those who waited longer, and that 1.65% of men who received the procedure within 90 minutes died, compared with 3.9% of those who waited longer (Anstett, Detroit Free Press, 11/13).