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Experts Call for Speedier Heart Care

Hospital Care Within 90 Minutes of Arrival Cuts Risk of Heart Attack Death

Medically Reviewed by Brunilda Nazario, MD on November 13, 2006
From the WebMD Archives

Nov. 13, 2006 - Speedier hospital treatment for heart attack victims could save lives, the American Heart Association (AHA) said today as it announced a program to speed up care.

Only about a third of those who suffer major heart attacks are being treated quickly enough, says the AHA. The campaign launched by the AHA and the American College of Cardiology (ACC) is designed to fix that problem.

Studies show that treatments like angioplasty plus a stent to prop open blocked arteries can cut the risk of dying by 40%. However, that holds true only if the procedure is done within 90 minutes of a patient's arrival at the hospital. If care is delayed even half an hour longer, the risk of dying shoots up about 40%.

"It's all about saving lives," says Steven Nissen, MD, a cardiologist at The Cleveland Clinic and president of the ACC.

The program, sponsored by the National Heart, Lung and Blood Institute, was announced here at the annual AHA meeting. It was simultaneously posted online by The New England Journal of Medicine.

Good Care=Rapid Care

The program consists of six steps aimed at getting people who suffer a common type of heart attack quicker treatment once they arrive at a hospital.

The average time between when a person comes in the hospital door and when he has angioplasty is currently 104 minutes, according to Elizabeth H. Bradley, PhD, of Yale University School of Medicine, who helped design the project.

"The variation between the fastest and slowest hospital in the U.S. is 20 minutes. That's huge." she says.

It doesn't matter if you have the best doctors, Bradley tells WebMD. It depends on how the system works, she says.

People interested in finding out the response times of hospitals in their area can go to www.hospitalcompare.hhs.gov.

6 Steps to Quicker Treatment

To design the program, Bradley and colleagues surveyed 365 hospitals for four years. They found six underused yet effective strategies to cut delays:

  • Requiring the staff that performs angioplasty to be at the hospital within 20 minutes of being paged. That could save 19.3 minutes, they say.
  • Having a cardiologist on site at all times; this would save 14.6 minutes.
  • Having paramedics perform an ECG en route to the hospital. This could alert the ER that a person is having a heart attack and activate the angioplasty team at the hospital, for a savings of 15.4 minutes.
  • Having a central operator page the angioplasty team, using a one-call system rather than having ER staff alert each individual doctor. Savings: 13.8 minutes.
  • Letting ER doctors activate and prepare the procedure room for angioplasty instead of waiting for a cardiologist to review a case and decide what to do. That would save 8.2 minutes.
  • Giving real-time feedback to the ER staff and those involved in the case: 8.6 minutes saved.

"With each step, we can wring out a few minutes," Bradley says.

More than 200 institutions have already joined the effort, endorsed by the National Heart, Lung, and Blood Institute, according to the researchers. Among those participating: Premier Health Care Services, Kaiser Permanente, and the Veterans Administration.

Call 911

Though this program is aimed at doctors, Nissen urges the public to do their share as well.

Most people wait two hours or more before calling 911, usually due to denial, he says.

"To really make a dent in the problem, people have to act more quickly if they have signs or symptoms of a heart attack," he tells WebMD.

"Despite the fact they're suffering chest pain, they'll say it's not a heart attack. It's even a bigger problem for women, who may have symptoms that are not typical -- such as sweating or nausea," says Bradley. "We need to get people to the hospital right away."

According to the AHA, warning signs of a heart attack that rate a 911 call are:

  • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
  • Discomfort in other areas of the upper body. This can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
  • Shortness of breath. This comes along with chest discomfort but can occur before such discomfort.
  • Other symptoms. These may include nausea, lightheadedness, or breaking out in a cold sweat.

While women may be more likely than men to have some of the other symptoms of heart attack, chest pain continues to be the most common symptom in both sexes.

If you experience these symptoms, don't wait; call 911.

Show Sources

SOURCES: American Heart Association's Scientific Sessions 2006, Chicago, Nov. 12-15, 2006. Steven Nissen, MD, The Cleveland Clinic; president, American College of Cardiology. Elizabeth H. Bradley, PhD, Yale University School of Medicine. The New England Journal of Medicine web site, Nov. 13, 2006. American Heart Association web site.

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