Slow care after heart attack tied to deaths

NEW YORK Tue Jun 21, 2011 4:23pm EDT

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NEW YORK (Reuters Health) - Hospitals that can't do heart attack procedures are taking too long to send patients on to centers that can, according to a new study that links the tardiness to higher death rates.

Researchers found that only about one in ten patients with the deadliest type of heart attack was transferred within the recommended 30 minutes.

That's likely to influence how well those patients do, and could be a major problem because three-quarters of U.S. hospitals can't do emergency heart attack procedures, according to the new study.

Only half as many of the patients transferred after half an hour or less died compared to those who had to wait longer.

"Patients who leave the hospital in less than 30 minutes have much lower mortality," said study researcher Dr. Tracy Wang, a cardiologist at Duke University School of Medicine in Durham, North Carolina. "We should really accelerate our efforts to get patients the care they need."

Wang and colleagues used data on nearly 15,000 transfer patients from 298 hospitals. The patients had suffered a kind of heart attack called ST-elevation myocardial infarction, or STEMI, which almost 250,000 Americans experience every year, according to the American Heart Association.

The best treatment for this condition is percutaneous coronary intervention (PCI), during which doctors clean out blocked arteries in the heart and leave a stent, or small mesh tube, to help keep the artery open. Ideally, PCI should be performed within 90 minutes of the patient's arrival at the first hospital.

The researchers, whose findings appear in the Journal of the American Medical Association, found that it took 68 minutes on average to get patients on their way to a hospital that could perform emergency PCI.

More than a third of the patients spent at least 90 minutes at the first hospital, meaning it would be impossible for them to get PCI within the recommended period.

Wang said many of those people would probably have done better with clot-busting medications instead of getting a delayed PCI.

Overall, she told Reuters Health, "Hospitals should be able to transfer the vast majority of their patients within 30 minutes."

Within that time period, patients get an electrocardiogram (EKG) to find out if they need PCI, and doctors call the nearest place that performs the procedure.

Of those patients who spent more than half an hour in the first hospital, twice as many -- about six percent -- died after arriving at the second facility, compared to less than three percent of patients who were out the door in 30 minutes or less.

While that doesn't prove slowness itself triggered the extra deaths, the gap couldn't be explained by delayed patients being sicker or older, for instance, according to the researchers.

"You need to grease the wheels a little bit," Wang explained, for instance by ensuring clear communication between hospitals and avoiding unnecessary procedures such as repeat EKGs.

There are already programs in place to try to cut unnecessary time lags, including the American Heart Association's "Mission: Lifeline." These might help explain why over the study period, from 2007 to 2010, transfer patients spent less and less time at their first hospital.

Still, with the average patient waiting more than an hour before being transferred, Wang said there is room for improvement.

SOURCE: bit.ly/4HWZ7 Journal of the American Medical Association, online June 21, 2011.

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