Faster care hasn't cut heart attack deaths in hospitals

Although hospitals have sharply reduced the time it takes to get heart attack patients into treatment, they aren't saving any more lives, according to a study whose results have surprised even some of the country's leading cardiovascular experts.

Timely heart attack treatment has become a key measure of hospital quality, and Medicare now bases some of its payments on how well hospitals do in this area.

Hospitals shaved 16 minutes off the time it takes to get heart attack patients into treatment from 2005-2006 to 2008-2009, reducing that time from 83 minutes to 67 minutes, according to a story in today's New England Journal of Medicine.

The percentage of heart attack patients treated in 90 minutes or less climbed from 60% at the beginning of the study to 83% three years later, according to an analysis of nearly 97,000 hospital admissions.

This study included only patients with a type of heart attack called an ST-elevation myocardial infarction, a life-threatening emergency in which an artery on the heart is completely blocked.

Doctors need to unclog arteries and restore blood flow to prevent the heart muscle from dying, says study co-author Daniel Menees, an assistant professor of internal medicine at the University of Michigan.

While clot-busting drugs can help, experts now agree that the best option is to perform a cardiac catheterization, in which doctors use balloons to open up blocked arteries.

The new study suggests that speeding up hospital care isn't enough to save lives, Menees says.

In spite of recent improvements in "door-to-balloon" time — the time between when a heart attack patient arrives in the ER and when the balloon angiography begins — researchers found that the percentage of heart attack patients who die while in the hospital, about 5%, hasn't changed.

Irreversible damage from a heart attack can begin in 30 minutes. Most tissue death occurs in the first two to three hours, says co-author Hitinder Gurm, an associate professor at the University of Michigan.

"We're shaving off the last 10, 20 or 30 minutes" between heart attack and treatment, Gurm says. "But the total time that the artery has been blocked has not changed much. We need to move upstream. We need to get patients to recognize their symptoms faster and get to the hospital sooner."

Campaigns to reduce door-to-balloon times have created some unintended problems, Menees says. "I am concerned that in our 'race against the clock,' physicians are rushing to meet this goal and sending an increasing number of patients to the cath lab (for balloon procedures) who don't need it. This may result in the misdiagnosis of sick patients and ultimately delay treatment they may otherwise need."

Many hospitals now activate special teams to deal with heart emergencies. Yet up to one-third of these activations — when all team members come running — are false alarms, according to an editorial accompanying the new study.

A better predictor of survival might be "symptom to balloon time," says Suzanne Steinbaum, director of the Heart and Vascular Institute at New York's Lenox Hill Hospital.

"Patients need to be aware of the symptoms of heart attack and be encouraged to call 911 as soon as possible," Steinbaum says. While men often suffer from classic heart attack symptoms — such as chest pain, arm pain or shortness of breath — women may experience different symptoms, such as nausea, jaw pain, back pain, vomiting or heavy fatigue, she says.

Reducing door-to-balloon time may still help patients in the long term, says Theodore Bass, president of the Society for Cardiovascular Angiography and Interventions. Patients who lose less heart muscle may be less likely to suffer chronic heart failure, when the heart is too weak to pump blood properly.

This article is courtesy of USA Today.