Mayo Clinic has designed a new system to speed critical care to acute heart attack patients that dramatically reduces the time that elapses before patients undergo a life-saving procedure -- by as much as 45 percent in some cases.
This rapid response -- dubbed by Mayo Clinic as the FAST TRACK protocol -- saves both heart muscle and patient lives. Mayo researchers will report their results on March 26 at American College of Cardiology's 56th Annual Scientific Session
The most serious type of heart attack is known as an ST-elevation myocardial infarction -- STEMI for short. In a STEMI, critical arteries supplying the heart with blood are blocked. Previous studies have shown that the best treatment for STEMI patients is to open the blocked artery by inflating a balloon at the blockage site within 90 minutes of arriving at a hospital that has emergency angioplasty services. The 90-minute window is called door-to-balloon time. The shorter the door-to-balloon time, the greater the chance of survival, studies show.
In 2003, physicians at Mayo Clinic recognized the urgent need to expedite care for STEMI patients, says Henry Ting, M.D., the lead author and a cardiologist at Mayo Clinic who coordinates quality improvement efforts for cardiology services.
At that time, patients with STEMI arriving at Saint Marys Hospital on the Rochester Mayo Clinic campus had an average door-to-balloon time of 98 minutes. Even more concerning is the fact that STEMI patients who first reported to an outlying regional community hospital and then transferred to Saint Marys Hospital in Rochester had an average door-to-balloon time of 202 minutes.
"We knew we could do better -- and save more lives in the process. And the tremendous team effort of caregivers this required proved us right," Dr. Ting says. "Mayo's new FAST TRACK STEMI protocol dramatically reduced the time that elapsed from hospital arrival to balloon procedure -- nearly halving the time in the case of transfer patients arriving from regional hospitals to Saint Marys Hospital."
The study shows that Mayo Clinic treated 597 consecutive patients from May 2004 to December 2006. Data were logged for two patient groups: those presenting to the hospital in Rochester and those who reported first to a regional hospital -- sometimes as much as 150 miles away -- and then transferred to Saint Marys Hospital. For patients nearest Saint Marys Hospital, the median door-to-balloon time was improved by almost 30 minutes, decreasing by 31 percent, from 98 to 69 minutes. For farther-out patients from one of the 28 regional community hospitals who required transfer to Saint Marys Hospital, the median first door-to-balloon time improved by almost 90 minutes -- a 45 percent decrease, from 202 minutes to 116 minutes.
"In cardiac emergencies, time is heart muscle -- the more treatment is delayed, the more the heart suffers," Dr. Ting says. "This is why time is the most important tangible measure of quality for caregivers to optimize in order to save more lives in patients presenting with STEMI."