September 5, 2013
Faster Hospital Care Not Leading To Fewer Heart Attack Deaths
Michael Harper for redOrbit.com - Your Universe Online
Although hospitals have been successful in getting treatment to heart attack victims more quickly, the rate of death has remained relatively unchanged.The University of Michigan Frankel Cardiovascular Center has conducted a study measuring what they call “door-to-balloon” time, or the time between admission and angioplasty. In most cases hospitals are able to start surgery within 90 minutes and have worked to reduce this time with the understanding that working more quickly could save lives.
Now, after analyzing data from nearly 100,000 American heart attack victims between 2005 and 2009, lead author of the study, Daniel Menees, MD, says working faster doesn’t always mean fewer deaths. His paper is published this week in the New England Journal of Medicine (NEJM).
“The data suggests that efforts to reduce door-to-balloon time further may not result in lower death rates,” explains Dr. Menees, an assistant professor of internal medicine at the University of Michigan Medical School and an interventional cardiologist. Now he says the key to saving lives may be in education about heart attacks and making sure victims get to the hospital as quickly as they can.
“Potential strategies to improve care may include increasing patient awareness of heart attack symptoms, reducing delays for treatment once symptoms begin, and shortening transfer time between health care facilities once a heart attack is recognized.”
Dr. Menees’ coauthor, Dr. Hitinder Gurm, agrees, saying; "When the patient takes three hours to get to the hospital, the 60 minutes or 90 minutes it takes for treatment doesn't make as much of a difference.”
Dr. Menees said he chose the data he analyzed because it coincided with a national push to decrease door-to-balloon times in an attempt to lower death rates. While the time between admission and surgery had fallen by 20 percent as a result, five percent of heart attack victims admitted to the hospital died after receiving care. This number is nearly unchanged from four years prior to the push to reduce door-to-balloon times.
In fact, any further work done to decrease the time to care could end up harming heart attack victims. As hospitals begin to work more quickly to move a patient through the system, the margin for error begins to grow. With this new data in mind, Dr. Menees says working towards faster care shouldn’t be the ultimate goal of doctors.
“Intuitively, we’ve all believed that the sooner we take patients to the cath lab, the shorter we make those treatment times, the better our patients will do,” said Dr. Menees in an interview with Bloomberg's Michelle Fay Cortez. “That’s not necessarily true.”
Another interventional cardiologist, however, believes that Dr. Menees research doesn’t necessarily mean door-to-balloon time is a faulty point of reference.
"Door-to-balloon time is a core measure by which hospitals that do PCI (percutaneous coronary intervention) treatment are measured. That core metric is not going to go away based on this study, nor should it," explained Dr. Joseph Fredi, an interventional cardiologist at Vanderbilt University Medical Center's Heart and Vascular Institute, in an interview with Gene Emery of Reuters.
"I hope people don't take away from it that we can start relaxing and not have to move heaven and earth to not achieve that metric they way hospitals do now,” added Fredi.