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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Impact of Delay to Reperfusion on Mortality in ST-Segment Elevation Heart Attacks

Impact of Delay to Reperfusion on Mortality in ST-Segment Elevation Heart Attacks | Heart and Vascular Health | Scoop.it

In patients with large anterior myocardial infarction undergoing relatively early reperfusion, longer delays to reperfusion were associated with larger IS and 1-year mortality, but not with reduced reperfusion success.

Seth Bilazarian, MD's insight:

In this trial that made an effort to evaluate the effect delay in treatment has on death in anterior STEMI's (the most serious & deadly of the heart attacks) there was a large difference in survival at 1 year between those that were treated within 3 hours and those that were not.  

The absolute risk reduction for death at 1 year was 5.2%.  That means that every 20 patients that come to the hospital and are treated within 3 hours of their heart attack symptoms there will be one life saved.  Early heart attack education, awareness and action are critical.  

If you have chest pain lasting more than 5 minutes call 911 for the earliest and most effective treatment.

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Ten Ways Patients Get Better Medical Treatment - Includes FASTER heart attack care

Ten Ways Patients Get Better Medical Treatment - Includes FASTER heart attack care | Heart and Vascular Health | Scoop.it
From wireless EKGs to customer service, small steps aim to heal the whole person.
Seth Bilazarian, MD's insight:

Health-care innovations aren't limited to drugs and devices. Experts increasingly are adopting new ways to treat patients that studies show are better at healing the sick, preventing disease, improving patients' quality of life and lowering costs. Here are 10 innovations that took root in 2012 and are changing the care patients will get in 2013.The one that is most pertneinet to cardiology = >Heart Attacks Are Being Treated FasterSpeed is of the essence in surviving a heart attack, and in many cities now treatment starts before the patient reaches the hospital. Emergency medical technicians perform electrocardiograms and transmit results wirelessly to the emergency room. New guidelines from the American Heart Association and the American College of Cardiology aim to quickly restore blood flow when an artery is blocked, the most severe type of attack known by the acronym STEMI. Guidelines call for balloon angioplasty and stents as preferred treatments for STEMI, and clot-busting drugs as a stopgap measure. Also recommended: Chilling the patient in cases of cardiac arrest, a practice that reduces subsequent brain injury. In new research, survival rates were higher among cardiac-arrest patients who received CPR longer—a median of 25 minutes versus 16 minutes. For patients, the message is: Don't delay calling 911 when you have symptoms, and avoid going to the hospital in a private car.

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Why Severe Heart Attacks Are Becoming Less Deadly = Stents

Why Severe Heart Attacks Are Becoming Less Deadly = Stents | Heart and Vascular Health | Scoop.it

Severe heart attacks may not be as deadly as they used to be, according to new research.  A new French study demonstrated that patients hospitalized for severe heart attacks – technically known as ST-elevation myocardial infarctions – the chances of dying within 30 days dropped from 13.7% in 1995 to 4.4% in 2010, an improvement of 68%.
Researchers looked at data from nationwide registries in France 1995- 2010 of 6,700 patients who had heart attacks and were admitted to intensive care units. They found that the improvement in survival was likely related to a number of factors, including demographic changes, more timely presentation to hospitals, improvements in medications and treatments, and higher rates of STENTING open up blocked arteries.

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Diminishing Returns of Modern Medicine - fight to shave minutes in heart attack care

Diminishing Returns of Modern Medicine - fight to shave minutes in heart attack care | Heart and Vascular Health | Scoop.it
In-hospital mortality after an acute heart attack has dropped 10-fold, from 30 percent to 3 percent, since the invention of the modern cardiac care unit in the 1960s. Can shaving a few more minutes off the time it takes to get hospital treatment possibly yield any additional benefit?
Seth Bilazarian, MD's insight:

This is a good account of the problem with advancing medicine.  As we reduce bad outcomes closer to zero OF COURSE there is going to be much greater difficulty (this is the high hanging fruit)..  The author is right that because of the pressure of public reporting on door to balloon time (D2BT) sometimes decisions are rushed and this is an area of concern.

The example he provides of the cardiologist driving 90 mph is not appropriate because that is an example of a system problem that SHOULD be fixed.  Taking 60 minutes to figure out a patient has a heat attack is much to long and not good care.

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Improving 'Door to Balloon Time' (D2B) for Angioplasty Patients

Improving 'Door to Balloon Time' (D2B) for Angioplasty Patients | Heart and Vascular Health | Scoop.it

My comment : The particular kind of heart attack called STEMI identified by EKG is the highest immediate risk of all heart attacks and hospitals have dramatically improved systems of care to quickly open these blocked arteries.  Every minute more heart muscle is lost with a higher likelihood of death or severe long term complications such as heart failure.  The success described in the article is a great accomplishment for patients. The one part we are not improving is the "pain to door" time.  The longer the patient waits with chest pain to activate the emrgency system the worse the outcome.  Call 911 to start the "Race to Open a Blocked Artery".

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The current standard is 90 minutes, but many hospitals aim for a faster standard of as soon as possible.\Researchers who studied Medicare data from more than 300,000 patients at 900 hospitals found so-called door-to-balloon times fell from a median of 96 minutes in 2005 to 64 minutes in 2010. The best-performing hospitals regularly achieved times under 60 minutes, which "may become the new standard," the study, published last year in the journal Circulation, concluded.

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Systems of Care for Heart Attack => ST-Segment–Elevation MI from AHA

Systems of Care for Heart Attack => ST-Segment–Elevation MI from AHA | Heart and Vascular Health | Scoop.it

Key take away for patients:

This paper was a survey of over 300 hospitals that take care of the sickest type of heart attack called the STEMI.  Best practices to improve care by reducing the time to open up the artery (called door to balloon time (D2B)) were identified. 

 

These practices are:

1.  accepting patients at a PCI hospital regardless of bed availability

2.  single phone call activation of cath lab

3.  emergency department physician activation
of lab without cardiology consultation

4.  national data registry participation

5.  Prehospital activation of the catheterization laboratory by paramedics & transferring physicians.

 

The most commonly reported barriers to system
implementation were hospital and cardiology group
competition and EMS transport and finances.

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