Tuesday, November 14, 2006
Better Heart Attack Care For All

A couple of points seemed especially interesting to me about treating heart attacks in time - a story I was researching for a piece on "Paula Zahn Now" for tonight...

The first one is the bad news: Currently, there's no reliable way for a patient to select a hospital that is trained to treat heart attacks and give emergency balloon angioplasties in under the recommended 90 minutes. Only a few hospitals in the country - 1/3 of them - treat at least half of their emergency angioplasty patients in under an hour and a half. Until U.S. hospitals uniformly adopt procedures to minimize the time spent on these patients and make these measures public, heart attack patients are taking a bit of a gamble when it comes to choosing a hospital . How do you know when the odds are going to be stacked against you?

The other part - the good news - is that hospitals that are learning and changing their procedures to treat heart attack patients quickly may not only help save an additional thousand lives in the ER every year, but they may actually be able to "erase" the heart attack altogether. Meaning in some cases, when hospitals manage to open up the arteries quickly (like, say, in under an hour), subsequent heart function tests may not show that there was any damage to the heart muscle, as if the patient had never had the heart attack in the first place! This translates to reduced risk of heart problems in the future, a quicker recovery time, as well as other long-term heart health benefits. And, most of the changes that need to be made are focused on how the cardiac treatment team communicates and organizes itself - so it's not going to cost a lot for hospitals to implement these systemic improvements.

With increased awareness on the part of the hospitals, and a few inexpensive changes in the ER, more Americans can live longer and healthier lives in the aftermath of a heart attack.

How can someone find out which hospitals are the best for cardiac care?
That is excellent news. Heart attacks is on of the great lifestyle illnesses in the western world.

I to am surprised that there is no lists out, showing what hospitals provide the best care.

I believe if there was a register it would incourage the hospitals to improve their standards.
I thought that angioplasty was already a standard procedure that most if not all hospital medical providers were trained in. However if this is not the case it is encouraging to see that training is more common place. What a wonderful prognosis it would be for someone having had a heart attack and know that having received the proper care that there would be no damage to the heart.
Have you ever wondered why our medical system is in such a shambles? Part of it has to do with the public being able to obtain the correct information on how they need to respond to any particular event. This Blog article addresses the problem where hospitals are too slow responding to heart patient needs. That issue made its way through the press earlier this week. But now there are 'counter' articles being published, such as this one from USAToday,"http://www.usatoday.com/news/health/2006-11-14-heart-angioplasty_x.htm", that states that too many angioplasty's that are performed are not needed. This isn't politics - there should be a truth line in here somewhere!
Thank God the hospital I work at, and closest to my immediate family, works under the 90 minute premise. It takes coordination between local EMS, the ETC, and the Cath Lab to make this work. In addition, public service announcements that advocate "time is (heart) muscle" are imparitive to public education about getting to your local hospital ASAP. I have no doubt that this approach saved the life of my 46 year old brother in March of this year. He experienced atypical symptoms of extreme fatigue and nausea after working a 7 day work week. He realized his symptoms might be that of a heart attack and had his wife call the local squad. They started a "Rule out MI" protocol, faxed his 12 lead EKG to the hospital, and within 20 minutes of his arrival to the ETC was on the Cath Lab table, where the Cardiologist on call performed a life-saving cardiac stent procedure. I live and am an RN at a non-profit teaching hospital (300 beds) in a mid-west city. I am suprised to see by this CNN report that this life-saving protocol is not widely provided. We must advocate for this in all American cities.
Unfortunately I lost my son to a heart attack 3 weeks ago. He had warning signs but he was too busy to heed them and go to dr.This is a message to all, no small thing should be overlooked.
I had a massive heart attack last year. I was fortunate enough to be delivered to a catheter-ready facility at Union Memeorial in Blatimore in a short amount of time, depsite passing through another ER at another hospital. The mantra in both ERs was 'Time is muscle'. I went straight into the catheter operating theater and had three stents put in to open up 100% blockage in one artery and 95% in another.

No heart damage and cleared for work six days later. 16 months later I am still amazed at this being even remotely possible.

Everyone at every opportunity in this process was ready to help me and did so.
I recently had a heart attack and was one of the lucky patients that received prompt care. My ER visit was 5 minutes or less. I was whisked to the cath lab and received angioplasty with the placement of 3 stents. From the onset of symptoms to being post recovery was just over 2 hours.

My EKG is normal and my enzymes did not elevate. Things are looking good for this 52 year old.

Glad to live close to a hospital that "gets it."
I suffered a heart attack on a golf course last April.I was taken to the nearest hospital and received meds to break the clot. When that didn't work, I was taken to Cooper Hospital in Camden, NJ and received 2 stents.This all happened within a few hours but would have been better if I was taken directly to a hospital with a cath lab. I suffered no heart damage and am lucky and grateful to be alive.
This article is incredibly naive. It gives the impression that even if the patient somehow carried around a list of all hospitals that are enabled for advanced cardiac care, and that list which can change from location to location often within 10 or 20 miles, that the patient can "direct or request" that the paramedics take them to their hospital of choice. This is fiction. 99.999% of EMS responders are REQUIRED by protocol to take you to the NEAREST hospital. You don't get a choice. Ever. The quality of cardiac care at your closest hospital is dictated by local and state politics, as well as your insurance status. The first step to standard cardiac care is standard health care coverage, namely, universal health care coverage. Articles like this shift the focus away from the real problem.

Luis Rivera, MD
Department of Emergency Medicine
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