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August 24, 2011

Calif. hospital improves time for heart attack treatment

By Larry Mitchell
Chico Enterprise-Record

CHICO, Calif. — Enloe Medical Center has reduced the time it takes to get victims of severe heart attacks the treatment they need. Heart attack experts talk about "door-to-balloon" time.

That's the time that elapses between when a patient arrives at the hospital and when balloon angioplasty opens up the clogged artery so blood can flow again. A type of balloon is inserted into the closed artery and inflated. In March of last year, Enloe's median door-to-balloon time was 76 minutes.

In March of this year, it was 50.5 minutes.

"I think that shows collaboration of the whole system cardiologists working with emergency docs and the EMS (emergency medical services) providers," said Dr. David Burt, a national expert on heart attacks. "They should be commended for that."

Burt was in Chico to speak at a symposium on heart attacks Tuesday at the Enloe Conference Center. More than 100 doctors, nurses and other medical professionals attended the event.

Enloe's reduction in its door-to-balloon time is part of a national trend.

Burt said a new study shows a dramatic decline in door-to-balloon time in hospitals around the country. The national median is now 64 minutes, he said. "That's pretty good, but not great." He'd like to see it fall even lower.

Dr. Peter Magnusson, a Chico cardiologist and medical director of Enloe's cardiac catheterization lab, said locally efforts have been made to reduce door-to-balloon time since 2004, when the Chico hospital's angioplasty program began growing.

At first, he said, time was lost because the protocol called for an emergency-room doctor to notify a cardiologist, who then would summon personnel to the cath lab if it was at night or on the weekend.

Now, the emergency-room doctor decides to call in the cath lab staff.

Another improvement occurred in the past year, when a grant was received to equip ambulances with electrocardiographs, Magnusson said.

Now, EMS team members can do an electrocardiogram (EKG) in the field and transmit the results electronically to the emergency room. As a result, it's known sooner if the patient will need angioplasty.

Magnusson said a national goal is to have the door-to-balloon time 90 minutes or less for all patients.

Back in 2004 and 2005, Enloe was achieving the 90 minute goal for only 30 to 40 percent of patients, he said. "In the past year, we got it 90 to 92 percent of the time, and some quarters were 100 percent. We've challenged ourselves to get better at it."

Tuesday's symposium focused on a severe type of heart attack known as a STEMI (ST segment elevation myocardial infarction).

In this type of heart attack, one or more of the three large arteries that lie on the surface of the heart become clogged, usually abruptly, Magnusson said. When an EKG is done, a STEMI can be recognized. Angioplasty is the best treatment for a STEMI.

Thirty to 40 percent of heart attacks are STEMIs, Burt said. Last year, Enloe was designated a STEMI receiving center.

That means when a patient with a STEMI can be brought to Enloe within 30 minutes, he or she is taken directly there rather than to a closer hospital which is not equipped to do angioplasty.

Between July 1, 2009, and June 30, 2010, Enloe saw 47 STEMI patients, according to Christina Chavira, an Enloe spokeswoman. Between July 1, 2010, and June 30, 2011, there were 56 STEMI patients.

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