Cath Lab Digest

The ACC and AHA Launch National Alliance To Reduce Door-to-Balloon (D2B) Times

The American College of Cardiology (ACC), together with the American Heart Association (AHA) and other key national healthcare organizations, announced the launch of its latest quality campaign, Door to Balloon (D2B): An Alliance for Quality. A Guidelines Applied in Practice (GAP) Program, the D2B campaign is aimed at improving the timeliness of lifesaving therapy for patients with heart attacks at U.S. hospitals that perform emergency angioplasty.

Previously published guidelines developed by the ACC and the AHA recommend that hospitals treating STEMI patients with percutaneous coronary intervention (PCI) should reliably achieve a door-to-balloon time of 90 minutes or less. However, accomplishing this level of performance is an organizational challenge and many patients are not treated within the guideline recommendation. Thus, improving timeliness of treatment represents an important opportunity to improve the quality of patient care.

Harlan M. Krumholz, MD, SM, FACC, chair of the D2B Working Group and a multidisciplinary team conducted a study funded by the National Heart, Lung and Blood Institute in which 365 hospitals were surveyed to identify strategies that were significantly associated with a faster door-to-balloon time. Data from this study were simultaneously presented at AHA’s Annual Scientific Sessions in Chicago and published in the New England Journal of Medicine.

Several evidence-based strategies have been identified to assist hospitals in reducing their door-to-balloon times. The strategies involve multiple departments and require a systems approach. They include:

The emergency medicine physicians activate the catheterization laboratory (cath lab)

A single call activates the cath lab

The cath lab team arrives and is ready within 20-30 minutes

Real-time data feedback in the emergency department and the cath lab

Senior management commitment

Team-based approach

Over the coming months, participating hospitals will receive an implementation manual and tool kit, as well as information on how to best construct the team needed to implement the changes; what the roles and responsibilities of each member should be; and how to identify the point person for the project within each primary PCI hospital.

An update on the campaign will be given at the ACC’s Annual Meeting, ACC.07, in New Orleans from March 24-27, 2007.

Most U.S. Hospitals too Slow in Handling Heart Attacks

Most U.S. hospitals do not move fast enough to treat heart attack victims with life-saving emergency angioplasties, according to a study. The study, published in the November 16 New England Journal of Medicine showed that many hospitals did not follow federal guidelines to carry out the procedure in a timely fashion.

The faster doctors carry out the procedure, the higher the probability of survival, according to the study, which coincides with a meeting of the American Heart Association in Chicago.

Researchers from Yale School of Medicine identified several ways to speed up door-to-balloon time. The study, which included 365 U.S. hospitals, showed that the delay in performing angioplasty varied from between 55 and 120 minutes after arriving at the emergency room.

Federal recommendations are for less than 90 minutes. The risk of death rises 42 percent if the procedure is delayed at least 30 minutes, according to the researchers. Slightly more than one-third of heart attack victims in the United States obtain an angioplasty within the first 90 minutes. To gain time, the researchers urge activating the catheterization laboratory while the victim is on his way to the hospital, as well as improving coordination of hospital personnel and having a cardiologist on round-the-clock duty.

Despite the effectiveness of these strategies, a minority of the hospitals surveyed were using them, even though many of the strategies were feasible and could be immediately implemented, said lead author Elizabeth Bradley.

The publication of the research also coincides with the launch of a new campaign by the American College of Cardiology and the American Heart Association to speed up angioplasties and encourage hospitals to implement the strategies. One-third of the approximately 865,000 annual heart attacks in the United States can be treated with angioplasty.

Late Reperfusion Fails to Reduce Cardiovascular Complications

Balloon angioplasty plus stenting failed to reduce major cardiovascular complications in patients who had the procedure three to 28 days after a heart attack, researchers reported at the American Heart Association’s Scientific Sessions 2006. Results of the Occluded Artery Trial (OAT), a National Heart, Lung, and Blood Institute (NHLBI) funded international, randomized clinical study, were presented in a late-breaking clinical trials session. The trial included 2,166 people and is the largest and longest study to compare very late reperfusion to medication alone.

OAT was designed to help resolve a controversy about treatment of over one hundred thousand heart attack survivors in the United States alone each year: whether late opening of blocked coronary arteries would provide any long-term benefits to stable patients, said Judith S. Hochman, MD, OAT study chair and Harold Snyder Family Professor of Cardiology, clinical chief and director of the Cardiovascular Clinical Research Center at the New York University School of Medicine in New York City.