One-Third of Severe Heart Attack Patients Have Treatment Delays

Often, slowdown comes during patient transfers to another hospital, study finds

MONDAY, Sept. 19 (HealthDay News) -- More than a third of patients who experience a severe heart attack are delayed in getting the emergency artery-opening intervention they require, new research reveals.

Delays typically result from the fact that only a quarter of American hospitals are able to perform life-saving angioplasties. This means that many patients who experience a so-called "ST-segment elevation myocardial infarction" (STEMI) -- a total blockage of blood to the heart -- are quickly transferred out of the ER facility to which they are initially brought.

"While we are making tremendous progress, delays are still occurring during the transfer process," study senior author Dr. Timothy D. Henry, director of research at the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital in Minneapolis, said in an American Heart Association news release.

"This," he added, "is the first study that examines and identifies the specific reasons for delay of transfer patients."

Henry and his colleagues report their findings in the current issue of Circulation.

To get a snapshot of the problem, the authors focused on more than 2,000 STEMI patients in the Minnesota/Wisconsin region who underwent a hospital transfer between 2003 and 2009.

Transfers were all made to the Minneapolis Heart Institute (MHI), a facility equipped to perform angioplasties. In some cases, the initial ER facility was as much as 210 miles away from MHI.

Yet despite the distance, almost two-thirds of the patients were transferred without delay, arriving at MHI within two hours.

Nevertheless, more than 34 percent did experience a delay. And in almost two-thirds of such cases, those delays were attributable to the referring facility.

Referral hospital delays involved waiting for transport (26 percent); ER delays (14 percent); diagnostic dilemmas (9 percent); initial negative testing for heart attacks (9 percent); and cardiac arrest (6 percent).

The latter cause for delay was also the most likely to result in patient fatalities, the authors noted: 31 percent of those who went into cardiac arrest ultimately died before transfer.

Delays unrelated to the referral facility also took place. In nearly 13 percent of delay cases the cause was the transport process, while nearly 16 percent of the time treatment delays occurred at the MHI facility itself.

"Our ultimate goal is to improve timely access to angioplasty in patients with STEMI," Henry said. "We've been very successful doing this in hospitals that are equipped to provide the procedure. This study emphasizes that now our focus should be on regional systems which seek to incorporate those hospitals that require patient transfer in the process."

More information

For more on angioplasty, visit the National Heart Lung and Blood Institute.

Alan Mozes SOURCE: Circulation, news release, Sept. 19, 2011

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