Saving a patient from a heart attack requires swift action by a team working with assembly-line precision. But in cities across the United States, the medical response is nowhere near as efficient as your average auto plant.
One key reason: a lack of communication among emergency and hospital personnel.
A study published Monday in the journal Circulation shows it doesn’t have to be that way.
The study looked at a national demonstration project from the American Heart Association that sought to cajole rival hospitals and EMS providers in 16 regions to set aside their competitive instincts and agree on a plan to treat heart attack victims as soon as possible.
The effort resulted in notable, if modest, improvements in response times nationwide. Among patients transported by EMS, for example, 55 percent got to a hospital capable of performing emergency procedures to unclog arteries within 90 minutes, up from 50 percent before the project started.
For those transferred between hospitals, 48 percent got treated within 120 minutes, up from 44 percent before the project. Several cities recorded gains of more than 10 percentage points in one or both categories.
Quicker response times are associated with better survival rates, though the project did not result in a significant change in in-hospital mortality.
Experts said the key to improving response times was letting each region devise its own solutions.
“It turns out you can’t do this on a national level,” said Dr. James Jollis, a cardiologist at University of North Carolina Health Care. “It has to be done locally. You have to step forward and work with your colleagues.”
In Central Ohio, nearly a dozen hospitals reached agreement on a standard regimen of drugs to give to patients and devised a protocol to allow paramedics to bypass emergency departments and deliver heart attack patients directly to the catheterization lab.
“When we stripped away all of the bureaucracy and the competition, it really became easy,” said Dr. Ernest Mazzaferri Jr., medical director of the Ross Heart Hospital at Ohio State University. “Sharing data has probably been the best thing about this.”
In New York City, hospitals and the fire department worked to sign up more cardiologists to get emailed EKG results to speed up the decision-making process. They also agreed to bypass the emergency department in cases where a heart attack is obvious. Now, about 80 percent of patients go directly to the catheterization lab, officials said.
Dr. Jacqueline Tamis, associate director of the catheterization lab at Mount Sinai St. Luke’s Hospital in New York, said the project dramatically improved the response to heart attacks. And hospital and fire officials are now sharing data and meeting regularly to discuss ways to improve.
“The biggest change was the fact that we began meeting and we now know each other,” Tamis said. “If I have a question or a concern, I can immediately send an email to the fire department.”
Conducted between July 2012 and December 2013, the demonstration project was the largest ever to attempt to improve response times for treating heart attacks, the most lethal medical threat in the United States. It focused on people who suffered ST-segment elevation myocardial infarction (STEMI), a kind of heart attack characterized by an acute interruption of blood supply to the heart. It included nearly 24,000 patients treated by 1,253 EMS agencies and 484 hospitals in 16 regions.
Most of the participating regions developed step-by-step protocols for treating patients in the field and transporting them to hospitals with catheterization labs. Several incorporated elements of a treatment model created by the American Heart Association.
“US health care has a lot of great accomplishments and features, but one of its problems is fragmentation, particularly of emergency care,” said Dr. Christopher Granger, a professor of medicine at Duke University. “What this project did was go into these regions to pull people together to coordinate and integrate emergency care.”
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