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September 29, 2011

Heart attack victims get faster response at W. Va. hospital

Charleston Daily Mail

CHARLESTON, W. Va. — Most heart attack patients at Charleston Area Medical Center now receive treatment just over an hour after they arrive at the emergency room doors.

That's a big improvement over four years ago, but the average response time remains slower than the national average.

Tiny Arthur, associate administrator for heart and vascular services, said most heart attack patients' arteries are reopened within 76 minutes after they enter the hospital.

Since CAMC receives Medicare reimbursements, it is required to submit the response time data to the U.S. Department of Health and Human Resources.

CAMC has to report response times only for heart attack patients with complete artery blockages and no prior diagnoses, however. So far this year, only 70 cases met those requirements.

Response times have greatly improved since 2007, when the hospital first started collecting data.

That year, the average heart attack patient was treated 104 minutes after arriving at the hospital. There were 104 qualifying cases that year.

In 2008, the average response time in 67 qualifying cases dropped to 80 minutes.

In 2009, CAMC's response time increased to an average 91 minutes in 64 cases.

The average response time increased further in 2010 to 93 minutes, with 84 qualifying cases

Lisa Hoffman, director of CAMC's cardiac catheterization lab, said "time is muscle" when it comes to heart attacks.

Doctors fix blocked arteries using angioplasties. A surgeon inflates a small balloon inside a patient's blocked artery to reopen it for blood flow. The surgeon then places a tube, called a stent, in the artery to prop it open.

Heart muscles are more likely to recover from an attack if the blockage is reopened within 90 minutes, she said.

After the 90-minute mark, the heart muscle is permanently damaged. That usually leads to congestive heart failure or irregular heart rhythms down the line, Hoffman said.

Arthur said Medicare requires hospitals to treat patients within 90 minutes of arrival.

CAMC's response times lag the national average.

According to a recently published study in "Circulation," an American Heart Association journal, the median door-to-balloon response time in U.S. hospitals was 64 minutes in 2010.

That's down from 96 minutes nationwide in 2005.

The study included more than 300,000 patients in 900 U.S. hospitals who had emergency angioplasties. Only hospitals that receive Medicare reimbursements were included in the study.

"We have a lot of work to do, but we have seen a lot of improvement," Arthur said.

He said the hospital system is still trying to improve its response time, hoping eventually to reduce it to 60 minutes or less.

Arthur said CAMC has improved its response time by streamlining patients' path to the heart cath lab.

Paramedics in the field can tell when a patient is having a full-blockage heart attack by performing an electrocardiogram, a test that checks and charts the heart's electrical activity.

If the patient is experiencing a heart attack, paramedics tell CAMC and the receiving hospital initiates a "cardiac alert," Arthur said. That notifies the emergency room and cath lab staffs, who bump the patient to the front of the line upon arrival.

Arthur said the hospital also is trying to save time in other ways. He said CAMC emergency rooms now keep an EKG technician close by to run tests when the patient arrives.

The emergency department also provides "point of care" lab testing, helping identify heart attack indicators in patients' blood. The emergency room previously relied on the hospital's laboratory to process the samples.

Arthur said the hospital might change the heart cath lab's staffing patterns to further decrease response times.

Five days a week, the hospital system has an angioplasty team ready around-the-clock, Arthur said.

"In order to take that to the next step, we might have to take that to seven days a week," he said.

On other days, teams are on duty for 12 or 14 hours. The rest of the time, CAMC has doctors and nurses on-call. Those staffers are required to be at the hospital within 30 minutes of receiving a call.

Arthur said Hoffman regularly meets with hospital administrators, emergency departments and other staff members to review what went wrong when cases exceed the government's required 90-minute treatment time.

Of the 63 qualifying heart attack patients, only nine cases have exceeded that time limit. Each time, doctors missed the mark by only a couple of minutes, Hoffman said.

"That's the frustrating part, because you almost made it," she said.

Hoffman reviews how long it takes to get an EKG reading, how long it takes to get a patient into the cath lab, and how long it takes to get the blockage reopened, among other data.

"We focus on those that don't meet the 90 minutes so we can work to improve," Arthur said.

Hoffman said she suspects some of the cases have gone over 90 minutes because not all the hospitals' clocks are synchronized. The hospital is considering investing in a system where, once a heart attack patient comes in, they're given a clock that follows them from start to finish.

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