In Speed and Quality, UVa's Emergency Cardiac Care
Outpaces Goals of New Lifesaving Initiative
Headlines and news stories across the nation in recent days have announced the launch of a major national initiative to improve the speed and quality of lifesaving care for heart attack victims.
At the University of Virginia Health System, many of the rapid measures recommended by the new initiative are already in place and producing results achieved by only a few hospitals nationwide.
Called, "Door to Balloon (D2B): An Alliance for Quality," the national initiative aims to boost patient survival rates by accelerating treatment of a common type of heart attack. In medical terminology, these heart attacks are described as ST-elevation myocardial infarction (STEMI). One of the most effective treatments for STEMI is angioplasty, which uses a small balloon to open up blocked arteries.
Door-to-balloon time refers to the interval between a patient's arrival at a hospital and the insertion of an angioplasty balloon into their artery. Current guidelines call for D2B to be accomplished within 90 minutes, an interval in which STEMI patients have the best outcomes.
Propelling the launch of D2B is data showing that, nationwide, less than a third of STEMI patients receive treatment within 90 minutes and that even a 30-minute delay increases their mortality risk by 42%. The program aims to save lives by bringing hospitals performing emergency angioplasty into compliance with national guidelines.
At UVa, D2B care is already outpacing the 90-minute mark and fast approaching the hospital's own goal of 60 minutes or less. Since September, 100% of STEMI patients have received emergency angioplasty in less than 70 minutes after their arrival; the majority of them have been treated in well under 60 minutes.
"We updated our treatment procedures five years ago and continuously improve them. For the STEMI patients we treat each month, this means top-notch care and extraordinary results," said Dr. William J. Brady, vice chair of the Department of Emergency Medicine. "Our continuum of care starts on the street with EMS personnel and proceeds through our Chest Pain Center in the Emergency Room to the Catheterization Lab where angioplasty is performed and on to the Cardiac Care Unit (CCU)."
Three factors have been vital to UVa's responsiveness. First is the pre-hospital care that patients receive while traveling in ambulances or the Pegasus helicopter.
"Our rapid response begins with the review of 12-lead electrocardiograms (ECG's) by physicians while patients are en route to the hospital," noted Dr. Chris A. Ghaemmaghami, director of UVa's Chest Pain Center.
Next is the Chest Pain Center, which earlier this year became the first in the area and the fifth statewide to earn accreditation from the Society of Chest Pain Centers. In qualifying for this designation, the center met stringent patient management criteria for early recognition and treatment of heart attacks and other acute cardiovascular emergencies.
The third factor is the STEMI Alert Team, which Ghaemmaghami said operates much like a Trauma Response Team. "This multidisciplinary group of doctors and nurses is in action within a half hour of being paged," he explained. "When STEMI patients arrive at the hospital, they are surrounded by a medical team that ensures they receive the quickest and best care possible, from the emergency room to the Cath Lab and then onto the CCU for recovery."
As part of its continuum of care for heart attack patients, UVa also offers the area's only cardiac surgery program and cutting edge treatments through clinical trials. Continuous education keeps physicians and nurses updated on rapid assessment and treatment procedures for emergency cardiac patients.