WebMD Medical News
Laura J. Martin, MD
Aug. 22, 2011 -- More than 90% of patients who have a heart attack and need an emergency treatment to open the artery now have it within the recommended 90 minutes after they get to the hospital, new research finds.
Some patients get the treatment even more quickly, says researcher Harlan M. Krumholz, MD, the Harold H. Hines Jr. Professor of Medicine and Epidemiology and Public Health at Yale University School of Medicine. In a national analysis, his team looked at how quickly the treatment, angioplasty, was done in 2010, compared to 2005.
"The median time (half longer, half less) went from 96 minutes to 64," Krumholz tells WebMD. "I think it's breathtaking."
In 2005, 44% of heart attack patients who needed angioplasty were treated within the 90-minute window. In 2010, 91% were, the researchers found.
"This is outstanding news," says P.K. Shah, MD, director of cardiology at Cedars-Sinai Medical Center in Los Angeles. He was not involved in the study but reviewed the findings.
The study is published in Circulation:Journal of the American Heart Association.
During angioplasty, the blocked artery is opened. The doctor passes a thin balloon-tipped tube into the vessel. The balloon is inflated, restoring blood flow, and then withdrawn. In some cases, a stent will be put in to keep the vessel open.
Even though doctors knew speed was important, only one-third of patients who needed angioplasty got it within 90 minutes in 2002. Some had to wait more than two hours after getting to the hospital.
That triggered the Centers for Medicare & Medicaid Services to begin reporting publicly the percentage of patients who were treated within the recommended window.
Soon after, national efforts were launched by organizations, including the American College of Cardiology and the American Heart Association, to improve treatment times.
Doctors call the window the "door-to-balloon time."
Krumholz and his colleagues analyzed nationwide hospital data collected by the Centers for Medicare & Medicaid Services. It includes more than 300,000 patients. They had emergency angioplasty from Jan. 1, 2005, through Sept. 30, 2010, including some not covered by Medicare.
Every year, nearly 250,000 people in the U.S. have the type of heart attack that blocks part of the blood supply to the heart and requires angioplasty, according to the American Heart Association.
In 2010, 70% of the patients were treated in less than 75 minutes. In 2005, only 27% were.
A time window of 60 minutes may become the new standard, the researchers say.
This study did not look at the effect of the speedier treatment on death rates. However, Krumholz says other research, including his own, has found that treatment delays are linked with higher death rates.
Krumholz reports chairing a cardiac scientific advisory board for UnitedHealth.
The study results show ''a substantial and meaningful reduction" in the treatment time window, says Shah of Cedars-Sinai. "It dropped by almost 32 minutes over a period of six years. That's very good."
The effort to do that is great, he says. It requires doctors and others from the emergency department and the cardiac lab to work together. An efficient system must be in place to activate the whole team quickly.
Patients can also improve their odds of getting prompt treatment by getting to the hospital as quickly as possible if they suspect a heart attack.
To do that, know the potential warning signs. According to the American Heart Association, these may include:
SOURCES:Harlan M. Krumholz, MD, the Harold H. Hines Jr. Professor of Medicine and Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn.P.K. Shah, MD, director of cardiology, Cedars-Sinai Medical Center, Los Angeles.Krumholz, H. Circulation: Journal of the American Heart Association, Aug. 30, 2011.
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