Door-to-balloon time has dropped dramatically as hospitals rush heart attack patients into treatment, but a five-year study released Monday shows quicker hospital care has not saved more lives.
Heart attacks are a medical emergency and hospitals race against the clock to open the clogged artery causing the attack in 90 minutes or less.
Door-to-balloon time is the amount of time between a heart attack patient's arrival at the hospital to the time he or she receives an intervention, such as a balloon angioplasty, to open the artery.
The study published in the Archives of Internal Medicine showed no change in mortality, in spite of the drops in door-to-balloon time at Michigan hospitals from 113 minutes in 2003 to 76 minutes in 2008.
The U-M Cardiovascular Center and colleagues at Michigan hospitals tracked the outcomes of 8,771 patients with acute ST-elevation myocardial infarction, commonly known as a severe heart attack.
"Considerable effort has focused on reducing door-to-balloon time with the assumption that quicker care translates into a significant reduction in mortality," says study senior author Hitinder Gurm, M.D., an interventional cardiologist at the U-M Cardiovascular Center.
"When we looked at our data, the reduction in door-to-balloon time was dramatic. However, to our surprise and dismay, we found the number of patients who died had not changed," he says.
Deaths from these heart attacks remained at about 4 percent.
Current American Heart Association and American College of Cardiology guidelines recommend getting these patients into treatment in 90 minutes or less.
"Our results suggest that a successful implementation of efforts to reduce door-to-balloon time has not resulted in the expected survival benefit," says Anneliese Flynn, M.D., a resident in the U-M Department of Internal Medicine, and lead author of the trends study.
By the end of the study period, nearly 70 percent of Michigan patients received care in the recommended DTB time. The study examined whether patients did better because of it.
"We need to do a better job at educating patients and developing sytems of care so that patients get to the hospital quicker and not only worry about the time involved once they hit the hospital door," Gurm explains.
"To improve patient outcomes we need to focus on the entire event - from the moment a person experiences chest pain to the time they get treated," he says.
Although door-to-balloon time dropped, the study showed no improvement in the time between the onset of symptoms such as chest pain, and when patients arrived at the hospital.
"It could be that the negative impact of the increased symptom-to-door time among high risk patients is sufficient to mask any potential protective effect of the decreased door-to-balloon time," Flynn says.
The Cardiovascular Consortium, called BMC2, is a collaborative network of physicians and hospitals and involves 32 Michigan hospitals that performs percutaneous coronary intervention, such as angioplasty and stents to treat patients with coronary artery diseases.
BMC2 registry is a physician lead quality improvement collaborative that is supported by the Blue Cross Blue Shield of Michigan. The collaborative works to improve outcomes of patients undergoing PCI with a special focus on reducing complications, and improving safety, efficacy and appropriateness of procedures.
The University of Michigan has been the coordinating center for BMC2 since 1997.To learn more about signs and symptoms of a heart attack
Reference: "Trends in door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention," Archives of Internal Medicine, Vol. 170, No. 20, Nov. 8, 2010
Funding: Blue Cross Blue Shield of Michigan.Resources:
Shantell M. Kirkendoll | EurekAlert!
Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology
Pan-European study on “Smart Engineering”
30.03.2017 | IPH - Institut für Integrierte Produktion Hannover gGmbH
The Institute of Semiconductor Technology and the Institute of Physical and Theoretical Chemistry, both members of the Laboratory for Emerging Nanometrology (LENA), at Technische Universität Braunschweig are partners in a new European research project entitled ChipScope, which aims to develop a completely new and extremely small optical microscope capable of observing the interior of living cells in real time. A consortium of 7 partners from 5 countries will tackle this issue with very ambitious objectives during a four-year research program.
To demonstrate the usefulness of this new scientific tool, at the end of the project the developed chip-sized microscope will be used to observe in real-time...
Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.
The results will be published on March 22 in the journal „Astronomy & Astrophysics“.
Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...
Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.
Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...
In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...
20.03.2017 | Event News
14.03.2017 | Event News
07.03.2017 | Event News
30.03.2017 | Health and Medicine
30.03.2017 | Health and Medicine
30.03.2017 | Medical Engineering