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Feinstein Insitute for Medical Research
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Date: Aug 01, 2016
New Study Shows Deadly Heart Attacks Are Best Treated by Coordinating Prehospital and in-Hospital Care
A new study co-authored by Peter Berger, MD, senior vice president of clinical research for Northwell Health and professor of cardiology and medicine at the Hofstra Northwell School of Medicine, shows that when pre-hospital emergency medical services (EMS), emergency room staff in hospitals, and cardiac catheterization laboratory staff all work together in a coordinated manner, people suffering from deadly heart attacks received life-saving treatment sooner. These findings were published today in the American Heart Association’s journal Circulation.
ST segment elevation myocardial infarction (frequently referred to as STEMI) is a deadly type of heart attack that happens when the blood supply to the heart through one of the heart’s three arteries suddenly becomes completely blocked by a blood clot. The likelihood of death and severe heart damage from STEM1 is dramatically reduced by quickly opening the blocked artery by an angioplasty procedure with a stent, also known as a percutaneous coronary intervention (PCI); that procedure is performed in a catheterization laboratory in most large hospitals. A PCI promptly restores normal blood flow through the blocked artery. However, among the more than 250,000 people who have a STEMI each year in the US, only approximately half are treated within the recommended 90 minutes from the time the patient first comes in contact with a pre-hospital emergency medical technician or a health care provider in the emergency room. This is generally due to a lack of coordination among those who care for STEMI patients before and after they arrive at the hospital.
The new study, an analysis of a national quality initiative conducted between July 2012 and December 2013, is the largest effort to organize regional STEMI care in the US. It involved 484 hospitals and 1,253 EMS agencies in 16 regions in the country (including major cities such as New York, Houston and Atlanta); during the study period, 23,809 patients suffered a STEMI. Of those patients, 11,765 patients transported by EMS and 6,502 self-transported directly to PCI-capable hospitals, while 5,542 patients transferred from a hospital without a catheterization laboratory to a hospital with one. (Patients should always call 911 when they believe they may be suffering a heart attack, but many instead drive themselves or are driven by a family member to their local hospital.) In all of the regions that the authors worked with, they attempted to insure that national guidelines for treating STEM1 were implemented, including coordination between the different teams of health care providers involved in the treatment of heart attack patients, to see if time to treatment and health outcomes could be improved. The national guidelines indicate that the blockage in the heart artery should be opened in a catheterization laboratory and blood flow restored within 90 minutes of the patient’s first contact with emergency medical personnel for patients that call 911, or drive to a hospital with a catheterization laboratory. The goal for treatment is within 120 minutes for patients transferred from hospitals that do not perform PCI to those that do.
By implementing these guidelines, there was a statistically significant increase in the proportion of patients being treated within 90 or 120 minutes during a relatively short time frame (18 months) after the initiative was implemented.
“We demonstrated that coordinating care between pre-hospital emergency medical technicians in ambulances, emergency departments, and catheterization laboratory teams speeds the time to treatment, increasing the chances that patients will survive a deadly heart attack,” said Dr. Berger. “Unfortunately, currently, there room for improvement in treatment. It is our hope that care will ultimately be coordinated in all health care systems, in all cities...many lives will be saved.”
Detailed findings from the study: the following are percentages of patients meeting the guideline goals: 59 percent to 61 percent for all patients presenting directly to PCI-capable hospitals; 50 percent to 55 percent for those transported by EMS to PCI-capable hospitals; and 44 percent to 48 percent for those transferred from other facilities.