Heart Attack Response Times Not Reducing Fatalities
In a study published last week in the New England Journal of Medicine, researchers found that although response teams have reduced the amount of time it takes to administer medical care after a heart attack, the mortality rate has not changed.
The study tracked 96, 738 patient admissions in 515 hospitals nationwide over the course of four years. It looked at the response time of the medical team, in-hospital mortality rates, and 30-day post-discharge mortality rates. According to the most recent medical guidelines, the amount of time it takes to get a patient from the door, into a room, and begin undergoing procedures is 90 minutes. This “door-to-balloon time” has become a way of measuring the effectiveness of medical response teams.
According to the new study, however, door-to-balloon time is not a way to accurately assess effectiveness. Throughout the four years of this study, from 2005 to 2009, the door-to-balloon time in the 96,738 cases decreased overall from 93 minutes to 83 minutes in July 2005 to 67 minutes in June 2009. Despite this, there was no change in the mortality rate of the studied patients. In 2005, the in-hospital mortality rate was 4.8 percent; a number which decreased to 4.7 percent in 2008. Similarly, no significant difference was found in the 30 day out-of-hospital mortality rate.
These findings seem to suggest that although response times are decreasing significantly, these times cannot be seen as a means by which hospitals can measure teams’ effectiveness if mortality rates are not affected. The researchers involved in the study concluded that alternate or additional strategies to decrease response time must be considered in order to decrease the mortality rate for heart attack patients, both in-hospital and within 30 days of discharge.
An article also published last week in the New England Journal of Medicine suggests that these alternate methods should include pre-hospital care and instruction. Decreasing the amount of heart attack patients who are taken to the hospital for heart attack treatment will decrease the mortality rate more effectively than decreasing door-to-balloon time. The article points out that pre-hospital care and education by patients’ individual doctors will help reduce the amount of patients that come to the hospital in the first place, thereby reducing the mortality rate.