Death Rates Increase for 9 in 10 Heart Attack Victims

According to a recent study from researchers at the Duke Clinical Research Institute, only one out of 10 patients who suffer a major heart attack is transferred to another hospital to get necessary treatment within the recommended 30 minutes. This failure to adhere to the recommended first half-hour transfer to a hospital that could clear their heart blockage increased the death rate of these patients significantly in comparison to patients who were moved within 30 minutes.

Percutaneous coronary intervention (PCI) is the recommended treatment for many heart attack patients, as the procedure opens blocked coronary arteries. Unfortunately, roughly 75% of hospitals in the US do not have around-the-clock PCI capability, which makes a speedy transfer to a hospital that is able to perform the procedure vital for heart attack patients.

"Door-in-door-out time is a new performance measure that assesses the timeliness of care patients receive at the first hospital and the recommended time frame is less than 30 minutes," reported the study’s lead author, Tracy Y. Wang, MD, assistant professor of medicine at Duke.

"Until now, little had been known about this critical step in the care of these patients in need of urgent treatment,” continued Wang. “We were surprised to learn that so much valuable time is being lost."

The research team gathered data from an expansive national database of hospitals and patients, known as the National Cardiovascular Data Registry (NCDR) and Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG).

The study focused on 14,821 patients, all of whom had experienced ST segment elevation myocardial infarction and who were transferred to one of 298 hospitals for PCI between January 2007 and March 2010.

Door-in-door-out time was determined by the time period between arrival and discharge at the referral hospital.

According to the findings, an improvement was seen in door-in-door-out time, but only 11% of patients were taken away from the referral hospital within the recommended 30 minutes. Even worse, over one-third of the patients studied were forced to wait more than 90 minutes.

"This is important because we know that patient outcomes significantly improve the sooner the blocked artery is opened, and practice guidelines recommend that percutaneous coronary intervention be administered within 90 minutes of a heart attack's onset," Wang stated. "That is impossible if patients remain at the first hospital awaiting transfer to a hospital able to perform the procedure."

"The majority of these waiting patients may be eligible for alternative treatment, such as fibrinolysis, a 'clot-busting' medication used to open up blocked arteries, which can be delivered at the referral hospital," Wang continued. "Although PCI is the preferred treatment, if we know we cannot get a patient to PCI within 90 minutes, fibrinolysis should be considered in some of these patients."

Overall, the researchers found a 5.5% mortality rate among transferred heart attack patients.

Notably, mortality rate was increased in patients with door-in-door-out times that were over 30 minutes, at 5.9%.

Mortality rate for patients who waited less than 30 minutes was significantly lower—2.7%.

"Our results show that there is still room for improvement and these programs have successfully improved outcomes for patients by relying on efficient communication and coordination of care between referral and receiving hospitals, as well as emergency transport services," Wang concluded.

This study was published in the Journal of the American Medical Association.