News | December 08, 2009

Changes in Heart Attack Care Saves Lives

December 8, 2009 – The American College of Cardiology’s (ACC) Door-to-Balloon (D2B) Alliance reached its goal of 75 percent of patients with ST-segment elevation myocardial infarction (STEMI) having D2B times within 90 minutes by 2008. Results of the study are published in the Dec. 15-22, 2009, issue of the Journal of the American College of Cardiology.

The national campaign to reduce D2B time for patients suffering heart attacks sought to improve times because guidelines recommended and various studies show patients suffering a heart attack who are treated within 90 minutes of entering the hospital door have a higher rate of survival than those who are treated later.

In 2005, approximately one half of patients with STEMI who received a primary percutaneous coronary intervention (PCI) met the recommended 90 minute D2B time. The D2B Alliance was launched in November 2006 by the ACC and 38 partner organizations to help participating hospitals lower their D2B times. By March 2008, over 75 percent of patients in those hospitals had D2B times of less than 90 minutes.

“This ambitious effort to improve timeliness of heart attack care has reported marked improvements with the vast majority of patients receiving life-saving care within 90 minutes of hospital arrival, as recommended by clinical guidelines,” said Elizabeth H. Bradley, Ph.D., professor at Yale School of Public Health, and lead author of the study. “The improvement was across the nation, not just in a few hospitals or states. The movement changed the way heart attack care is delivered – for the benefit of patients.”

The authors conducted an evaluation of D2B times in 831 hospitals participating in the ACC’s National Cardiovascular Data Registry (NCDR) CathPCI Registry, from April 1, 2005, to March 31, 2008, to examine the use of D2B Alliance-recommended strategies, changes in D2B times before and after the launch of the program, and differences in D2B times for patients treated in D2B Alliance hospitals and hospitals not enrolled in the program. The prevalence of each strategy recommended by the D2B Alliance improved significantly during the time period measured, as did the three-year trend in patient D2B times within 90 minutes, from 52.5 percent in 2005 to 62.8 percent before the launch of the D2B Alliance in 2006 to 76.4 percent in 2008.

“This remarkable leap in performance is a tribute to the nation’s interventional cardiologists and other health care professionals who quickly adopted effective systems that were uncovered by NIH-sponsored research,” said Harlan M. Krumholz, M.D., Harold H. Hines, Jr. professor of medicine at Yale School of Medicine, and co-author of the study. “What is inspiring is how the cardiologists came together to improve care – leading change within their institutions even as it required them to work harder – because it was the right thing to do.”

“The incredible success of the Door-to-Balloon Alliance represents aspects of the best of healthcare delivery in the United States; the integration of the highest medical science, technology and our medical community through the organization and integration of systems of care leading to seamless translation of evidence based medicine into clinical practice,” said Ralph Brindis, M.D., president-elect of the ACC. “The ACC and the NCDR is proud to have played a role in this key accomplishment for our nation.”

More recent data collected by the ACC’s NCDR CathPCI Registry indicate that hospital performance has continued to improve beyond the end of the study period of March 31, 2008. The most recent available data, from June 30, 2009, show that 81.7 percent of eligible patients receiving primary PCI had D2B times of less than 90 minutes. The average D2B time has dropped significantly as well, from an average of 121 minutes at the end of 2005, to an average of 80 minutes as of June 30, 2009.

“This effort shows what is possible when healthcare professionals work together to quickly improve care through the use of strategies developed from rigorous research,” Dr. Krumholz said. “We think of breakthroughs as something that happens in the laboratory, but this research shows how we can generate knowledge by studying how top performers work and then transform the national care of patients with heart attacks.”

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