NEW ORLEANS -- 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."
Mayo's system of care to speed the process of taking care of these critically ill heart patients includes these key elements:
- Single-call instant alert to the care team. For patients arriving at Saint Marys Hospital, emergency room physicians can directly activate the catheterization lab team, without review of the case or approval by a cardiologist, by calling a single automated phone number that sends a simultaneous pager alert to all catheterization staff who are on-call days, evenings, nights, weekends and holidays.
- Electrocardiogram within five minutes of arrival to the ER. Patients with symptoms suggestive of heart attack who arrive at Saint Marys Hospital or one of the 28 regional hospital emergency departments in Minnesota, Iowa and Wisconsin receive within five minutes an electrocardiogram, a test that quickly identifies a STEMI.
- Direct line of communication to all care team principals. For patients arriving at regional hospitals, emergency room physicians can call one single phone number to speak immediately with an on-call cardiologist and simultaneously activate the catheterization lab staff and the air ambulance transport team at Saint Marys Hospital.
- Rapid loading by air ambulance. The air ambulance transport team developed an innovative "hot load" procedure where the helicopter engine is left on and the time to pick up a patient from landing to take-off is less than 10 minutes -- similar to a MASH unit.
- 24/7 readiness. The Mayo system was designed to provide this expedited care to achieve the best door-to-balloon time during regular hours -- as well as during off-hours on weekdays, weekends and holidays.
Before 2004, there were several delays in care of STEMI patients. These were due to processes for evaluation and various procedures required to activate the catheterization lab, Dr. Ting says. "These previous systems had been part of our health care delivery system for several decades, and it really took a team effort from highly committed physicians, nurses, technicians in the emergency room, cardiology, cath lab staff and medical transport crew members to redesign an entirely new system of care," he says. "It's been worth it, because we are delivering the best care -- opening a blocked artery -- faster and saving more lives. We also are actively sharing our learning and innovations to improve the system of care at all our hospitals in the Mayo System, including Mayo Clinic Arizona, Mayo Clinic Jacksonville and Mayo Health System, as well as collaborating with the American College of Cardiology on the national door-to-balloon quality initiative. Our solutions are simple and easy to disseminate and replicate for other health care systems in the United States."
EMBARGOED: Hold for release until
Monday, March 26, 2007, 10:00 a.m. EDT
American College of Cardiology
Co-authors of the study are Luis Haro, M.D.; Bernard Gersh, M.B.Ch.B.; Christine Bjerke; Choon-Chern Lim; Ryan Lennon; John Bresnahan, M.D.; Allan Jaffe, M.D.; David Holmes, M.D.; Malcolm Bell, M.D.; and Charanjit Rihal, M.D.