Hospitals are racing against the clock to give heart attack patients lifesaving care faster than ever before.
They are implementing strict guidelines to open clogged arteries within record time, a move that experts nationwide say can lead to less heart damage, reduced costs and shorter hospital stays.
"We took a look at ourselves and said this is really taking too long," said Dr. Joon Sup Lee, clinical director of the Cardiovascular Institute at the University of Pittsburgh Medical Center. "We found that unacceptable."
Lee is talking about the so-called "door-to-balloon time," a phrase commonly used in hospitals to describe the amount of time it takes doctors to perform a procedure called angioplasty on emergency room patients.
Angioplasty involves inflating a tiny balloon at the site of the heart blockage and often inserting a stent. It is the standard way of treating severe heart attacks.
It gained momentum earlier this year when the federal government began ranking quality in the nation's hospitals based in part on their ability to perform angioplasty within 90 minutes of the patient's arrival.
That time frame, according to the American Heart Association and the American College of Cardiology, can save lives: the less time a heart is starved of blood and oxygen, the less damage to the heart muscle. Those who get angioplasty within the recommended guidelines are likely to cut their risk of dying by about 40 percent.
In the past year, UPMC Presbyterian has cut its door-to-balloon time to 73 minutes from 110 minutes. Among other things, the Oakland hospital has done it by evaluating all potential victims of a heart attack within five minutes of their arrival and by allowing emergency room doctors to make key decisions instead of consulting with cardiologists.
At Allegheny General Hospital in the North Side, heart specialists six months ago created a heart attack alert team that is activated immediately after being notified that a patient is en route. The team eliminates steps such as registration, and in some cases has achieved door-to-balloon times of less than 60 minutes.
"Time is muscle for us," said Dr. Tony Farah, medical director of the cardiac catheterization laboratories at AGH. "The heart is a muscle, and every minute that goes by without treatment, you're damaging more muscle. Beyond a certain point, damage is irreversible."
Timeliness is so crucial that angioplasties are being performed at cardiac catheterization laboratories in smaller community hospitals to slice off precious minutes wasted while traveling to larger but faraway hospitals.
"There's a big push to have cath labs, I hate to say in every corner, but at least in every hospital," said Dr. Michael L. Steinfeld, director of telemetry and non-invasive cardiology at West Penn Hospital-Forbes Regional Campus, where a heart and vascular center opening next year will have a cardiac catheterization lab.
Nearly 1 million people nationwide have heart attacks each year, according to the National Institutes of Health. About 200,000 people die before they can reach the hospital.
Scientists and doctors have debated for years whether angioplasty or clot-busting drugs to restore blood flow to the heart is the better weapon against heart attacks.
The drugs at one point were believed to be a better option because they could be quickly administered in emergency rooms, said AGH's Farah, who has always felt the treatment of choice should be angioplasty.
Angioplasty became more popular as studies showed it to be more beneficial.
A study published in the November issue of the New England Journal of Medicine explained that angioplasties can be done quickly if several guidelines are followed, including having paramedics perform an electrocardiogram en route to the hospital.
UPMC and the West Penn Allegheny Health System say they are working with emergency medical service organizations to make sure they have advanced EKG machines, similar to those used in hospitals.
EKGs measure the heart's electrical activity and quickly can tell doctors whether a patient's arteries are severely blocked.
Already several emergency medical service organizations have the machines, and that has greatly contributed to decreasing the door-to-balloon time, Lee said.
"Ideally, if you get an EKG before the patient comes in, you've already pre-identified that patient as someone that needs rapid transit through the system," he said.
