Great Gains: Almost All Heart Attack Victims Get to Angioplasty on Time
From 2005-2010, average time from hospital admission to angioplasty decreased from 96 to 64 minutes
Aug. 22, 2011 - Great news for senior citizens: nearly all heart attack patients who require emergency artery-opening
procedures are treated within the recommended 90 minutes from hospital arrival, compared with less than half the patients just five years
prior, according to a report in Circulation: Journal of the American Heart Association.
Angioplasty for these patients should be performed as quickly as possible, preferably within 90 minutes of hospital
arrival. During the procedure, a doctor opens the blocked artery by passing a thin balloon-tipped tube called a catheter into the heart
vessel, restoring blood flow.
The period from hospital arrival to angioplasty is called “door-to-balloon” time, also known as D2B.
For ST-segment elevation myocardial infarction (STEMI) patients, quick response is critical because this type of heart
attack is caused by a complete blockage of blood supply to the heart. Every year in the United States, nearly 250,000 people suffer this type
of heart attack.
In one of the most comprehensive analyses of angioplasty timeliness, investigators found that:
● 91 percent of patients were treated in a D2B time of less than 90 minutes in 2010, compared with 44 percent in 2005.
● 70 percent were treated in less than 75 minutes in 2010, compared with 27 percent five years earlier.
● The median time from hospital admission to emergency angioplasty declined from 96 to 64 minutes during the years
“Everybody had to improve to get a national report card like this,” said Harlan M. Krumholz, M.D., lead author of the
study and Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at Yale University School of Medicine in New Haven,
“This remarkable improvement demonstrates what we can achieve when we work together and is a tribute to the doctors,
nurses and other healthcare professionals that applied the information from the research studies about how best to deliver care to ensure that
patients are treated rapidly.”
Each year over a million
people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don't get
help immediately. It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms
● Chest discomfort -
pressure, squeezing, or pain
● Shortness of breath
● Discomfort in the upper
body - arms, shoulder, neck, back
These symptoms can sometimes
be different in
What exactly is a heart attack? Most heart attacks happen when a clot in the coronary
artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat – called an arrhythmia
- that causes a severe decrease in the pumping function of the heart. A blockage that is not treated within a few hours causes the
affected heart muscle to die.
If you have
coronary artery disease, the arteries in your heart are narrowed or blocked by a sticky material called plaque. Angioplasty is a
procedure to restore blood flow through the artery.
The doctor threads a thin
tube through a blood vessel in the arm or groin up to the involved site in the artery. The tube has a tiny balloon on the end. When
the tube is in place, the doctor inflates the balloon to push the plaque outward against the wall of the artery. This widens the
artery and restores blood flow.
Doctors may use angioplasty
● Reduce chest pain caused
by reduced blood flow to the heart
Researchers analyzed nationwide hospital data, collected by the Centers for Medicare & Medicaid Services, from more than
300,000 patients undergoing emergency angioplasty Jan. 1, 2005, to Sept. 30, 2010, including those not covered by Medicare.
The recent progress stems from a concerted nationwide effort between federal agencies, healthcare organizations and
clinicians to improve heart attack care and outcome by accelerating treatment, Krumholz said.
Several of the major initiatives include:
● Hospital Compare, launched in September 2005 as part of The Centers for Medicare & Medicaid Services’ program
to publicly report the percentage of patients treated within recommended times;
● D2B Alliance, launched in November 2006 by the American College of Cardiology with national partners to
improve D2B times by advocating the adoption of key strategies shown to reduce delays based on a study funded by the National Heart, Lung, and
● Mission: Lifeline, launched in May 2007 by the American Heart Association to improve community-wide systems
of care for patients with STEMI. Through Mission: Lifeline, systems of care are working to get patients to call 9-1-1 faster, to improve the
response time and capabilities of the emergency medical service teams. It will also provide faster triage and transport from hospitals that
don’t provide angioplasty to those that do, and to ensure the receiving hospitals’ team is in place ready to treat the patient as quickly as
possible upon arrival.
“The findings of this study are remarkable in that there has been a dramatic improvement in timely care of heart attacks
across the entire country,” said Chris Granger, M.D., chairman of the Mission: Lifeline steering committee and Professor of Medicine and
director of the Cardiac Care Unit at Duke University Medical Center in Durham, N.C.
“It shows what can be accomplished with systematic quality improvement efforts based on sound evidence. The results of
this study reinforce the value of ongoing efforts to extend these improvements to emergency medical services, networks of hospitals and to all
aspects of care of heart attacks, as is now being done in Mission: Lifeline.”
“At the beginning of these efforts, many said that this level of improvement was impossible to achieve,” Krumholz said.
“This is an opportunity to reflect on our achievement and to recognize that, when we identify quality issues and problems in our healthcare
system, we can work as a community to generate new knowledge to apply to practice and improve care for patients.”
Co-authors are Jeph Herrin, Ph.D.; Lauren E. Miller, M.S.; Elizabeth E. Drye, M.D., S.M.; Shari M. Ling, M.D.; Lein F.
Han, Ph.D.; Michael T. Rapp, M.D., J.D.; Elizabeth H. Bradley, Ph.D.; Brahmajee K. Nallamothu, M.D., M.P.H.; Wato Nsa, M.D., Ph.D.; Dale W.
Bratzler, D.O., M.P.H.; Jeptha P. Curtis, M.D. Author disclosures are on the manuscript.
The Centers for Medicare & Medicaid Services and the National Heart, Lung, and Blood Institute funded the study.
About Mission: Lifeline
About 400 hospitals and about 570 community-based STEMI systems are now registered with the American Heart Association’s
Mission: Lifeline, representing coverage of more than 58 percent of the
U.S. population. To learn more about how Mission: Lifeline can make a
difference in your community, visit: www.heart.org/missionlifeline