Better, Faster Heart Attack Victim Care

The Reperfusion of Acute Myocardial Infarction in North Carolina Emergency (RACE) study, led by researchers at Duke University Medical Center (Durham, NC, USA) was based on a trauma system and involved caregivers at 65 hospitals and associated emergency medical teams throughout North Carolina (USA). Over the two years of the program, physicians collected information on 2,000 patients, measuring pre and post-intervention times for key processes: the time from when the patient arrives at the hospital door to either angioplasty or clot-busting therapy, the time it takes for a patient at a feeder hospital to enter and leave the transferring hospital, and the time a patient enters a feeder hospital to treatment at a second, receiving hospital. To that end, paramedics were trained to do the work of emergency room physicians and emergency room physicians were trained to do the work of cardiologists. A single phone call from the field was enough to bring an angioplasty team to the catheterization lab, and hospitals had to admit heart attack patients, even if they did not have any available beds.

The results showed that the reaction times improved substantially in all areas. Median time from door to treatment for hospitals offering angioplasty fell from 85 to 74 minutes (a 22% improvement); median time from door to infusion of clot-busting therapy fell from 35 to 29 minutes (17% improvement); median time from door-in to door-out at transfer hospitals fell from 120 to 71 minutes. (41% improvement); and
the median time from arrival at a feeder hospital to beginning treatment at a receiving hospital fell from 149 minutes to 106 minutes (29% improvement). The study was presented at the annual meeting of the American Heart Association, held during November 2007 in Orlando (FL, USA).

"Cardiologists had to give up some of the control we were used to having,” said senior author cardiologist Dr. James Jollis, M.D. "It was a hard habit to break. But once we saw the results, we knew we could trust the process.”


Related Links:
Duke University Medical Center