"Time-to-treatment is important. The effectiveness of angioplasty in the treatment of heart attacks is highly dependent on the timeliness of therapy. There are some hospitals that are achieving great performance; and if you break down their approach, you can see many key strategies that can be applied more broadly, so perhaps best practice can become typical practice," said Harlan M. Krumholz, M.D., S.M., F.A.C.C. from the Yale University School of Medicine in New Haven, Connecticut.

American College of Cardiology and American Heart Association treatment guidelines say hospitals equipped to perform emergency angioplasty procedures should try to reopen blocked blood vessels of heart attack patients within 90 minutes of a patient's arrival. The study authors produced a flow chart that outlines the steps successful hospitals took to meet that "door-to-balloon" time standard. Key steps include:

• Equip and train ambulance crews to perform electrocardiograms (ECGs) in the field
• Use the "pre-hospital" ECGs to trigger activation of angioplasty teams
• Allow emergency medicine physicians make the activation call without waiting for a cardiologist to confirm a heart attack diagnosis

The researchers also said that the hospital staffs accepted the fact that there were occasional "false starts" in which angioplasty teams would get ready and then be told to stand down. The events were seen as a reasonable tradeoff for dramatically trimming door-to-balloon times and reducing heart muscle damage in those patients who were indeed having heart attacks.

The researchers used a national registry of heart attack treatment performance to identif
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Contact: Amy Murphy
amurphy@acc.org
301-581-3476
American College of Cardiology
28-Sep-2005