One Heart Attack Patient in Three Must Wait to be Treated
Dr. Timothy D. Henry, director of research at the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital in Minneapolis, and his colleagues have recently published a report relating to treatment delays for heart attack patients. The report is in the current issue of the medical journal Circulation.
One of the findings showed that over 33% of patients having a serious heart attack cannot receive the emergency surgery which will open their arteries in a timely fashion. Part of the problem is that only 25% of hospitals in the United States can perform the angioplasties, the name for the life saving intervention required.
A ST segment elevation myocardial infraction, also known as STEMI is the condition where the blood flowing to the heart is blocked. When patients are admitted to the emergency room of a hospital without the facilities or staff to carry out the angioplasties procedures then that patient is transferred to a hospital with adequate facilities. That is the first delay in receiving treatment.
Dr Henry points out that, “”While we are making tremendous progress, delays are still occurring during the transfer process”. He adds, “This is the first study that examines and identifies the specific reasons for delay of transfer patients”.
The study centered on the Minnesota and Minneapolis region in the U.S. from 2003 until 2009 and 2,000 patients with STEMI symptoms were investigated. Central to the investigation was the Minneapolis Heart Institute (MHI), a hospital able to carry out angioplasties. All the patients investigated were transferred from their initial emergency room to this hospital from distances as great as 210 miles, about 336 kilometers.
The findings showed that almost 66% of these patients arrived at MHI within two hours and with no delays. However, the remainder, about 34% was subject to a delay. Of this group, nearly 66% of the delays were attributable to the original ER facility.
The reasons for the referring hospitals delays were varied. The most common reason was that transport was not readily available (26%), delays in the emergency room accounted for another 14%. Additionally problems with the diagnosis and the extra time involved was responsible for 9% of the hold ups, initial results from the testing for heart attacks being inconclusive resulted in another 9% and the patient going into cardiac arrest caused the final 6% of delays.
The delays caused by cardiac arrest were the ones responsible for most of the fatalities. It was seen that of those who had a cardiac arrest only 69% made the transfer successfully. The other 31% died before the transfer could take place.
Of the other delays not connected to the referring hospital almost 13% were related to transport and 16% occurred as treatment delays in MHI.
Doctor Henry reiterates, “Our ultimate goal is to improve timely access to angioplasty in patients with STEMI and we’ve been very successful doing this in hospitals that are equipped to provide the procedure”.
He believes that the results of the study indicate that it is now time to focus on regional systems to ensure that any patient referral arrangement between hospitals is an effective and efficient process.