According to new research, People having a heart attack get faster life-saving treatment to restore blood flow to the heart if they live in states that allow emergency medical crews to bypass hospitals that don't offer the specialized treatment in favor of hospitals that do. The study was publsihed in the journal Circulation: Cardiovascular Interventions.
The study looked at how quickly heart attack patients received percutaneous coronary intervention, or PCI, a preferred treatment to open blocked arteries. Not all hospitals have the specialized capability to perform PCI, so researchers compared treatment times in states with and without policies that allow emergency medical services (EMS) to take patients directly to hospitals that offer PCI, even if that means bypassing closer facilities.
In this study, 57.9% of patients living in states with hospital bypass policies received PCI within relevant guideline-recommended times, compared to 47.5 percent of those living in states without bypass policies. The analysis involved 19,287 patients treated at 379 hospitals in 12 states. Researchers compared time to treatment for heart attack patients receiving care in 2013 and 2014 in six states with bypass policies to treatment times for patients in six states without bypass policies.
Even though the time from symptom onset to hospital arrival did not differ across states, patients treated in states with bypass policies received faster intervention once they contacted emergency medical services.
1. In states with bypass policies, 57% of people having heart attacks received PCI within 90 minutes or less of first medical contact and 82% underwent PCI within 120 minutes or less of first medical contact.
2. Those numbers were significantly lower in states that did not have bypass policies, where 45% of people received PCI within 90 minutes or less and 77% within 120 minutes or less.
The goal is to improve and expedite care from the moment a person first has symptoms, to calling 9-1-1, getting to the right facility to get the right treatment and continuing through hospital discharge, rehabilitation, and recovery. Although much work has already been accomplished to expedite the care of these patients, we need to continue to put together all the pieces of this puzzle to provide the best possible heart attack care for our patients.
They note areas for improvement including:
1. Routine use of pre-hospital ECG transmission (and early cath lab activation)
2. Development of community-based educational outreach programs to improve patient symptoms recognition
3. Continued development of regionalized systems of care for STEMI patients to reduce the overall time from EMS activation to reperfusion therapy.
This study strengthens the case for state government leaders in developing robust systems of EMS care that can triage and transport patients with time-critical conditions such as heart attacks.