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| MGH Team Exceeds National Standard For Quick Response To
Heart Attacks |
But Many Marin Residents Wait Too Long Before Seeking
Medical Help
Heart attack patients arriving at Marin General Hospital's Emergency
Department are more than twice as likely to receive emergency
angioplasty within the optimal 90 minute time period than patients at
the average hospital in California or the nation, according to a new
national report.
Cardiologist Dr. Joel Sklar, medical director of the Marin Heart
Institute at Marin General Hospital, said, "This may contribute to the
outstanding mortality rate at MGH that is approximately half that of
similar hospitals."
The American College of Cardiology and the American Heart Association
guidelines state that the national standard for 'door to dilation
time' (first arrival at the ED to initial angioplasty treatment)
should be 90 minutes or less.
According to the National Registry of Myocardial Infarction (NRMI)
"MGH was able to get 80 percent of its patients into the angioplasty
suite (the Cardiac Catheterization Laboratory) and get the blocked
coronary artery open within 90 minutes," Sklar said. "However, NRMI
reported only 30 to 35 percent of patients in California and
nationwide received angioplasty treatment that fast."
Marin General treated 214 heart attack patients last year, according
to the NRMI report, with 175 arriving at the Emergency Department and
39 transferring from other hospitals. Of the non-transferred patients,
35 were treated by emergency angioplasty in the MGH Cath Lab.
"The patients who were eligible for emergency treatment to open the
artery had a mortality rate of only 1.6 percent," he said, "while the
mortality rate for all non-transferred patients was 5.7 percent. This
compares with a mortality rate of from 9.2 percent to 10.1 percent at
similar sized hospitals in California and the nation."
Emergency Angioplasty Only Available At MGH
Emergency angioplasty is available in Marin only at the hospital's
Cath Lab, which provides the service 24 hours a day, seven days a week
by an on-call team of cardiologists and staff. Patients from Novato
Community Hospital are also treated there.
Not all heart attack patients require emergency angioplasty. That
decision is based on each patient's clinical situation, but Marin
General was able to treat a higher percentage of patients with
angioplasty than most other hospitals, according to the NRMI report.
Sklar said the reason a community hospital like MGH can achieve these
results is because of the quick response by the medical team.
"We have a small, motivated and dedicated team of ED physicians,
cardiologists and Cath Lab staff that give high priority to heart
attack patients," Sklar said. "Our state of the art equipment is a big
help but, more than that, it's our team's willingness and commitment
to make things work that helps us to achieve such excellent results."
Some Marin Residents Wait Too Long Before Seeking Help
The NRMI data also showed that many Marin residents wait longer than
the national average to seek medical help at the onset of symptoms.
The quicker a patient dials 911 and is rushed to the hospital, the
better the odds are for receiving the best and most effective
treatment.
"Marinites seem to wait significantly longer before arriving at the ED
for treatment of their heart attacks," Sklar said.
It took patients eligible for emergency angioplasty, who were
transported directly to MGH from their home, an average of 125 minutes
from the onset of symptoms to arrival at the ED, the report said. The
lapse time was about 90 minutes in similar sized hospitals.
Ideally, patients should arrive at the ED as soon as possible after
the first signs of a heart attack.
Sklar said, "Sure, a heart attack victim can arrive at our ED, be
diagnosed and sent to the Cath Lab for treatment within 60 minutes.
But, if he waited two hours to call the paramedics he may have lost
much of the benefit of what we can do. Heart muscle cells start dying
the minute the blood flow is cut off and, every bit of heart muscle
counts.
"If our patients take 125 minutes to get to the ED, but in other
communities they take 90 minutes, this difference of 35 minutes is
significant. Those 35 minutes may make the difference between a big
heart attack and a little heart attack."
It may also make the difference between living and dying, or living
with long term problems like congestive heart failure, he said. "The
more time an artery is blocked, the more heart damage there is. So,
the sooner you get angioplasty to unblock the artery, the less heart
damage there is likely to be."
Angioplasty More Effective Than Clot Busters
However, Sklar said it is better to wait several hours for emergency
angioplasty than to wait one hour for clot dissolving drugs.
"We've been using emergency angioplasty to treat heart attacks
patients since April 1999 and many studies now confirm that the
procedure is superior to clot dissolving drugs," Sklar said.
Many studies confirm the superiority of opening clogged arteries with
balloons and other devices as
the initial therapy rather using than clot-dissolving drugs like
tissue plasminogen activator, or TPA.
A person having a heart attack may experience some or all of the
following:
- Pressure, fullness discomfort or squeezing in the center of
the chest. It lasts for more than a few minutes or goes away and
returns
- Pain that goes to your shoulders, neck or arms
- Sweating, discomfort in the chest, lightheadedness, faint,
upset stomach or shortness of breath
Women, however, may not often experience such symptoms and may often
only notice weakness, nausea, heartburn or other less obvious signs.
They and their doctors need to be extra alert to the possibility of
heart attack.
June 9, 2003
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