A recent report released in the New England Journal of Medicine online shows that only one third of hospitals provide emergency care to heart attack patients quickly enough to save additional lives. The patient’s arrival to the emergency room and the so called window between diagnosis and treatment is essential in improving outcomes in many patients with sever obstructive cardiac disease.
We asked Dr. Louis E. Teichholz, chief of cardiology at Hackensack University Medical Center in Hackensack, N.J., about the significance of this study. His hospital has been a leader in this field, including being in the top 10 percent for
acute myocardio infarction
care in the Medicare demonstration project, and in terms of mortality in the top 5 percent, according to Healthgrades.
Dr. Manny: A new study showed that only about one third of hospitals provide emergency care to heart attack patients quickly enough to meet scientific guidelines for saving lives. Why do you think so few hospitals meet these criteria?
Dr. Teichholz: To meet the time guidelines- one first needs a "culture" to strive for excellence. Then one needs to develop a team approach and flow out each step in the process, develop appropriate guidelines for each step, monitor concurrently the data and re-adjust the processes using test-of-change and the Continuing Quality Improvement process.
Dr. Manny: What should patients look for in cardiac emergency services?
Dr. Teichholz: Ideally, patients should be taken to hospitals that have put in place the appropriate processes (as in Question 1). Consumers can look at the quality of the hospitals by looking at the CMS website hospitalcompare.com, or others such as healthgrades.com to see.
Although clot busting drugs can be used when primary angioplasty is not available, the use of a balloon and stents is clearly better if it can be done quickly.
Dr. Manny: What typically happens in an emergency room when a patient is confronted with possible heart attack?
Dr. Teichholz: Patients with a possible heart attack should be immediately seen and a full electrocardiogram done within 10 minutes of arrival so that an immediate decision can be made by the emergency room physician-without any delays in contacting and discussing with a cardiologist. The team can be activated and the goal is to open the artery causing the heart attack within 90 minutes. Time is myocardium (heart muscle)--the sooner that the artery is opened, the less the damage and the better the prognosis.
Dr. Manny: What should consumers expect from their emergency paramedic service or police squads?
Dr. Teichholz: The leaders in this area attempt to make the diagnosis before the patient gets to the emergency room-so as to activate the team and reduce the time to opening of the artery. This can be accomplished by the taking of an appropriate history and physical exam in the field by EMS and taking a full electrocardiogram in the field and transmitting it to the emergency room prior to the arrival of the patient.
In addition, we need to have a major effort to educate patients about the symptoms of heart attack so that there are no delays from the onset of symptoms until the patient decides to activate 911. This is a major problem since many patients wait even hours with the pain, thinking it is indigestion. It has been shown that in about one-third of the time, the patient with a first episode will die before getting to the hospital.
Dr. Manny Alvarez serves as Fox News Channel's senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. For more information on Dr. Manny's work, visit AskDrManny.com.