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Full Speed Ahead in Heart Attack Care

If you’re having a heart attack, there’s no time to waste. “Time is heart muscle,” explains Richard Bach, MD, Washington University cardiologist at Barnes-Jewish Hospital and medical director of the Cardiac Intensive Care Unit (CICU). “The heart is so critically dependent on constant blood flow. The sooner we can treat a heart attack and open the clogged artery blocking blood flow, the less heart muscle damage is done.”

Timing is especially critical for patients with a certain type of heart attack called ST-segment elevation myocardial infarctions, or STEMIs. These attacks are more immediately life-threatening. The best way to treat STEMI patients is to reopen the clogged artery as quickly as possible using a balloon angioplasty or related procedure in the catheterization lab, now called percutaneous coronary intervention (PCI).  

Constantly Improving the Rapid Response

Heart attack care at Barnes-Jewish is carefully choreographed for maximum speed and minimum delays through every step in a patient’s care – from the field to the emergency department to the cardiac catheterization lab to the CICU. Statistics support Barnes-Jewish Hospital’s rapid heart attack care. Currently, 92 percent of patients in need of balloon angioplasty receive one within 90 minutes at Barnes-Jewish. The national average is 149 minutes.

Barnes-Jewish was one of only 17 hospitals out of nearly 4,500 in the country – and the only one in Missouri – reported by Medicare in 2007 to have superior, above-average heart attack survival rates.

Barnes-Jewish actively works toward shaving off as much time as possible for PCI for every patient with STEMI. “We’ve restructured from the ground up, from pre-hospital care to the emergency room to the catheterization lab,” Bach says. “Across the board, we have motivated, caring and responsible physicians and staff members who strive very hard to work as rapidly as possible. We’ve radically changed our approach to care, which translates into a low mortality rate.”

Even while seeing the most complex heart cases, Barnes-Jewish was one of only 17 hospitals out of nearly 4,500 in the country – and the only one in Missouri – reported by Medicare in 2007 to have superior, above-average heart attack survival rates.

Nelda Martin, ANP, clinical nurse specialist in cardiology at Barnes-Jewish, is the coach for the emergency heart care team, always pushing them to be better. She reviews every patient case to make sure goals have been met, and if they aren’t, she finds out why and how the results can improve.

Part of Barnes-Jewish’s speedier care is due to a team approach that involves improved coordination and communication with the emergency medical services (EMS) crew. A system is being created so that EMS technicians can transmit a 12-lead EKG from the field to the emergency room that shows whether or not the patient is having a STEMI.

“Studies show the 12-lead EKG done in the field can reduce overall treatment time by about 15 minutes,” Bach says. “That’s significant when every minute counts.” After the EKG is transmitted, a physician
reviews it and decides whether to immediately call in the cardiac catheterization team, who are available 24 hours a day. Meanwhile, a Rapid Response Nurse gets the catheterization lab and the patient readied.

“By the time the team arrives the patient is ready to go and prepped for catheterization,” Martin says. “We were one of the first hospitals to take this unique approach and now have taught others to do it.”

When It’s Better with a Conservative Approach

While patients with STEMI require immediate treatment, patients with non-STEMI heart attacks are treated more conservatively.

Less risky heart attacks can first be stabilized in the emergency department. These patients may have more EKGs, blood work, a heart ultrasound, and a later diagnostic cardiac catheterization.

“This conservative approach can be safer for these patients,” Martin says. “It gives the heart time to settle down and allows us time to decide what’s the next best step. We truly customize care for the individual.”

She says Barnes-Jewish is a “one-stop shop” so patients don’t have to be transferred somewhere else if they need another type of cardiac procedure. “We have the best cardiologists and surgeons in the country here plus we offer extraordinarily good treatment times. We also have four floors just for heart patients with dedicated cardiology nurses.” 

Leading Heart Care Innovations Then and Now

Barnes-Jewish has played major roles in key advances in heart care and research over the past 35 years. In the 1970s, physician-scientists at Barnes-Jewish helped develop the use of enzyme markers as a way to diagnose an acute heart attack. Today, this has become the standard of care across the country.

Physician-scientists at Barnes-Jewish also first pioneered the use of PET (positron emission tomography) scanning to detect abnormalities associated with acute heart attacks. This led to some of the fundamental concepts of the current well-accepted benefit of early reperfusion therapy to open blocked arteries.

In addition, Washington University physicians have conducted some of the major clinical research trials providing the most important advances in treatment of heart attack, heart failure and coronary artery disease over the last decade. They are identifying new treatments in patients with acute coronary syndromes (ACS), which include heart attacks and the type of chest pain that may progress to a heart attack. And other trials are studying new agents for intensively reducing cholesterol after an acute coronary syndrome, which can reduce the likelihood of more heart attacks in the future.

When in Doubt, Call the Experts

Heart attacks are expert mimics. They can be disguised as indigestion, fatigue, or the flu. Rarely are they dramatic, clutch-the-chest “TV” heart attacks.

“Chest pain is the number one complaint that comes through the emergency department at Barnes-Jewish,” explains Nelda Martin, ANP, clinical nurse specialist in cardiology. “Yet frequently women, the elderly or those with diabetes have less typical symptoms such as gastric distress, shortness of breath and dizziness. If these last more than three or four minutes and keep recurring, it’s important to get checked quickly at the hospital. The safest way to do that is to call 911, even if you’re not sure if it’s a heart attack.”

Bach agrees. “We see too many patients in the CICU who have serious consequences because they delayed coming to the hospital. When in doubt, pull the trigger. It’s much better to call 911 than to wait and try to figure out if you’re having a heart attack.”

Webinar #2 - Heart Disease

What is an angioplasty? What is a stent? What are tips to prevent heart disease? Those answers and more in this episode of our Wednesday Webinar series from June 15, 2011 with John Lasala, MD, PhD, director of the cardiac catheterization lab at Barnes-Jewish Hospital and Washington University School of Medicine.

 

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