Hospitals drop ball on heart attacks, researchers say

Only about one-third of hospitals provide emergency care to heart attack patients quickly enough to meet scientific guidelines for saving lives, researchers reported Sunday. Even the top performers meet the American Heart Association and American College of Cardiology guidelines for prompt care in just half of their cases, researchers say. "Even among the better hospitals, only a few hospitals routinely meet the recommended guidelines," says Yale cardiologist Harlan Krumholz, a leader of the research team and an architect of a national campaign launched Sunday to help hospitals improve their performance. "By next year, we're going to change that."

About 200,000 people a year have heart attacks caused by blockages in crucial arteries that supply the heart with blood. About 10,000 patients die of these heart attacks in hospitals each year.

Studies show that reopening clogged arteries by inflating a tiny balloon at the site of the blockage is the best way to treat a severe heart attack. The procedure, balloon angioplasty, can cut a patient's risk of dying by 40 percent, but only if it is done within 90 minutes of the patient's arrival at the hospital, the "door-to-balloon" time. If every hospital met the guidelines, Krumholz says, doctors could save about 1,000 lives each year. A study reported in March in the journal Circulation showed that 80 percent of people live within an hour's drive of a hospital that provides balloon angioplasty.

Yet only about one-third of heart attack patients get angioplasty within the 90-minute window. The new study surveyed 365 hospitals to determine what procedures they have in place to get patients angioplasty quickly. Just 35 percent reported an average door-to-balloon time of 90 minutes or less, 48 percent had a door-to-balloon time of 91 to 120 minutes, 13 percent came in at 121 to 150 minutes and 4 percent topped 150.

The study was released Sunday at an American Heart Association meeting and online by the New England Journal of Medicine. Hospitals agreed to participate if they weren't individually identified. Doctors said consumers can contact their local hospitals and ask whether they meet the American Heart Association and American College of Cardiology guidelines for heart attack care. The study was designed to help launch the new campaign, called D2B, by providing hospitals with ways to improve performance. "This is a national undertaking to try to save the lives of people who have heart attacks," says Steven Nissen of the Cleveland Clinic and president of the American College of Cardiology. "We're losing too many lives."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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