Research Case Study: Heart Attack Treatment

At Fletcher Allen, patient care is informed by research. The following case study is one example of how a research study is helping to improve the care of heart attack patients.

Situation

Patients suffering from heart attack need emergency, life-saving treatment to open up blockages in their arteries. Each minute the heart is deprived of oxygen increases the chance of disability and death.

The American College of Cardiology and the American Heart Association recommend that patients with severe heart attack receive treatment to open blocked arteries — such as balloon angioplasty or stenting — within 90 minutes of first arriving at a hospital.

In rural Vermont and northern New York many patients do not have local, immediate access to these types of procedures and need to be transferred to another facility.

Across the country, the issue of providing timely intervention for patients with severe heart attack is an ongoing challenge. Most patients are first taken to hospitals that don't have cardiac catheterization labs. When every minute counts, the extra time to transfer patients can mean the difference between life and death.

Solution

In 2007, Fletcher Allen and the University of Vermont launched a pilot program — creating a streamlined system of care for patients in outlying areas with severe heart attack.

The program allowed for the rapid transfer of patients from a community hospital to Fletcher Allen. The goal was to open blocked arteries within 90 minutes of when the patient first arrived at the community hospital's emergency room – a time interval known as "door-to-balloon" time.

Fletcher Allen worked in partnership with local emergency medical services and emergency department staff to establish protocols for the program. Patients received rapid initial drug therapy at the community hospital prior to being transferred.

To further speed the process, Fletcher Allen Emergency Department staff were able to activate the cardiac catheterization laboratory with a single call to a central paging operator. Cath Lab staff were then expected to arrive within 20 minutes after being paged.

From February 2007 to August 2008, Fletcher Allen/University of Vermont physicians studied the outcome of the pilot program to determine its success, with "door-to-balloon" times and other time intervals carefully measured.

Benefits

The program succeeded in achieving "door-to-balloon" times equal to or under 90 minutes for more than 70 percent of the patients – rates that are far below the national average. The pilot transfer system serves as a model for other states as they look to improve care for heart attack patients.

Heart attack patients in Vermont and northern New York can be assured that they are receiving the best possible life-saving treatment, regardless of where they live.
For example:

• Vermont is among the top five states in the nation for heart attack survival, according to a recent national study of hospital admissions.
  
  
• Fletcher Allen has one of the lowest “door-to-balloon” times in the nation, exceeding the national average.

All of this means our patients receive some of the best care for heart attack in the country, care that increases their chances of living a healthier, longer life.