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Should heart attack care be more like trauma care? Study suggests regional system could be feasible

In a heart attack, every minute counts. But should patients spend a few more of those minutes getting to a hospital that can provide the most advanced treatment, rather than just the closest hospital?

That question is at the heart of a current debate among heart specialists: whether to make heart attack care more like trauma care, with ambulance crews taking certain patients to specialized hospitals that can perform emergency heart procedures, rather than stopping at the closest hospital.

A new study looks at a crucial issue in that debate: how close Americans live to hospitals that can perform angioplasty, which is considered the best treatment for the form of heart attack called STEMI, if it's done quickly. Only a fraction of American hospitals perform angioplasties, which re-open blocked blood vessels in the heart and can be done electively to prevent a heart attack or urgently to treat one.

The new research shows that nearly 80 percent of Americans live within an hour's ambulance trip of an angioplasty-performing hospital. The University of Michigan and Yale University research team made the finding by combining and analyzing census data, hospital locations, driving distances and estimated driving times,

The researchers also found that the closest hospital to about 58 percent of Americans doesn't do angioplasty. But the extra drive time to an angioplasty hospital would be less than 30 minutes for most of them, though many patients in rural areas would have farther to go.

The research will be published March 8 in the journal Circulation, and will also be presented March 13 at the annual meeting of the American College of Cardiology.

"There are many more issues involved in regionalizing heart attack care, with proximity to specialized hospitals being necessary, but not sufficient, for making such a system feasible," says lead author Brahmajee Nallamothu, M.D., MPH. an assistant professor of internal medicine at
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
6-Mar-2006


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