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Heart Attack Patients Not Being Transferred For Treatment Quick Enough | Ormond Beach Medical Malpractice Lawyer

Heart Attack Patients Not Being Transferred For Treatment Quick Enough

Only about 10 percent of heart attack patient who need to be transferred to another hospital for treatment are transferred within the recommended time of 30 minutes, according to a new study.

The study looked at patients suffering from a ST-segment elevation myocardial infarction (STEMI). STEMI is the most serious and deadly type of heart attack, characterized by a complete blockage of a coronary artery.

It requires rapid response and treatment to reopen the artery and restore blood flow to the heart muscle. The preferred treatment is primary percutaneous coronary intervention (PCI), which involves mechanically opening the artery using a small balloon to clear the blockage followed by the insertion of a stent, a type of scaffolding used to prop open the artery.

Yet, according to the study, approximately 75 percent of hospitals in the United States currently do not have acute PCI capability.

“Patients with STEMI who present initially to these STEMI referral hospitals are frequently transferred to a STEMI receiving hospital for primary PCI,” according to background information in the article. “Most important, the duration of time from arrival to discharge at the first hospital (i.e., the door-in to door-out time) is largely unknown.”

The arrival to discharge time measure is increasingly being advocated as an important metric of processes of care to expedite reperfusion, and a national benchmark of less than 30 minutes has been recommended.

Dr. Tracy Y. Wang of Duke University Medical Center, Durham, N.C., and colleagues conducted a study to examine the time to reperfusion, which is restoration of blood flow to the heart, and patient outcomes associated with the door-in to door-out time of 30 minutes or less. The study included data on 14,821 patients with STEMI transferred to 298 STEMI receiving centers for primary PCI in the Intervention Outcomes Network Registry between January 2007 and March 2010.

Among the STEMI patients in the study transferred to a STEMI receiving hospital for primary PCI, the median time from door-in to door-out was 68 minutes. Only 1,627 patients (11 percent) had a time of 30 minutes or less; 56 percent had a time of greater than 60 minutes and 35 percent had a time of greater than 90 minutes.

Independent patient characteristics associated with a door-in to door-out time greater than 30 minutes included older age, female sex, off-hours presentation, and nonemergency medical services transport to the first hospital.

The researchers found that patients with door-in to door-out time of 30 minutes or less were more likely to undergo primary PCI after arriving at the STEMI receiving hospital compared with patients with a time greater than 30 minutes (95.9 vs. 90.5 percent).

Overall door-to-balloon (DTB) time was significantly shorter for patients with a door-in to door-out time of 30 minutes or less compared with those with a time greater than 30 minutes.

The percentage of patients with an overall door-to-balloon time of 90 minutes or less was significantly higher for patients with an arrival to discharge time of 30 minutes or less compared with those with a door-in to door-out time greater than 30 minutes (60 percent vs. 13 percent); similar results were observed for the percentage of patients achieving an overall DTB time of 120 minutes or less.

During the study period, the researchers observed a 5.5 percent in-hospital mortality rate that was significantly higher among patients with a door-in to door-out time of greater than 30 minutes (5.9 percent) compared with patients who had a time of 30 minutes or less (2.7 percent).

This door-in to door-out time “is a new reperfusion performance measure for patients with STEMI who require interhospital transfer for primary PCI,” the authors write. “Our study shows that patients with a time of 30 minutes or less are more likely to achieve an overall door-to-balloon time of less than 90 minutes and are associated with lower risk-adjusted mortality compared with patients who had a door-in to door-out time greater than 30 minutes, thus affirming the importance of this time as a metric for reperfusion quality.”

“The majority of transferred patients with STEMI nationwide do not meet the recommended 30-minute benchmark,” the authors write, “suggesting that further attention and improvement of this performance measure will translate into substantial improvement in the timeliness of primary PCI and clinical outcomes for transferred STEMI patients.”

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.



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