Fast Response to Heart Attacks

Genesis Medical Center, Davenport is writing the book on fast response to heart attacks -- or at least a chapter.

The success behind the hospital's rapid care for heart attacks will be highlighted at the upcoming American College of Cardiology conference on March 29-April 2, when a textbook on the topic will be unveiled.

Genesis' heart attack alert process will be detailed in a chapter written by cardiologist Nicolas Shammas, M.D., MS, of Cardiovascular Medicine, P.C.; Marie Williams, RN, MBA, supervisor of cardiac quality and outcomes; and, Cindy McGee, RN, BS, manager of the Cardiac Catheterization Lab.

"During a heart attack, time is muscle and muscle is life," Dr. Shammas said. "The sooner we can open up the blocked artery with balloon angioplasty in the Cath Lab, the chances are overwhelming that there will be good healing to the heart muscle, less damage to the pumping function of the heart and better survival."

Heart Attack Alert

The average "door-to-balloon" time -- meaning from when the patient enters the hospital's Emergency Department to the opening of his or her blocked artery in the Cath Lab -- has improved since Genesis instituted a heart attack alert system in June 2004.

"After more than 275 heart attack alerts, our median response time at Genesis, Davenport is 55 minutes," McGee says. "That's considerably faster than the national standard of care of less than 90 minutes set by the American College of Cardiology. Our record time is 17 minutes."

Across the nation, it's estimated that less than a third of hospitals meet that 90-minute goal.

"Since we instituted our alert system, we have decreased our response time by 42 minutes," Williams added. "To put it in perspective, that's more time than it takes to watch a half-hour sitcom on T.V.

"All of our protocols for getting the patient into the Cath Lab are evidence-based. Many of these were in place two years before the American College of Cardiology recommended them to all hospitals in 2006."

Dr. Shammas said the book editor was very complimentary of Genesis' contribution. "Genesis can do a lot to teach people how to make that door-to-balloon time shorter," he said. "We've gone through the process for several years and refined it. We do this very, very well."

He added: "We're not just opening up an artery and happy because we've done it within 50 minutes. We're happy because we have done a great service to the patient by allowing better healing to the heart muscle and allowing them to live longer."

Genesis also has begun heart attack alert protocols with the cities of Burlington, DeWitt and Maquoketa and is in the process of rolling them out to other communities, as well.

At Genesis, the clock starts ticking from the time the heart attack patient enters the Emergency Room doors, and most times, emergency medical technicians in the field have given advance warning to the hospital and performed the EKG. It ends once the blocked artery is opened.

The 2004 creation of the Genesis alert coincided with aggressive national guidelines for treating ST elevation myocardial infarction, or STEMI. Every minute counts for this form of heart attack.

Responding to a 911 call, EMTs advise the hospital’s Emergency Department of a potential heart attack alert whenever a 12-lead electrocardiogram shows a “ST-segment elevation.”  Such a reading indicates a heart attack in progress and an urgent need for emergency angioplasty.

“The EMTs are our eyes and ears out in the field,” McGee said. “Their role is crucial, particularly because many times precious time is lost when people postpone calling 911 at the onset of heart attack symptoms.”

The Genesis alert simultaneously notifies the Emergency Department, Cath Lab and affected hospital departments, including Nursing, Lab, Pharmacy, Respiratory Care, Spiritual Care and Security. The hospital begins responding before the patient even arrives. The Genesis Medical Center, Illini Campus, also has instituted a heart attack alert process.

The Davenport and Illini campuses of Genesis are members of the "D2B Alliance," an international campaign spearheaded by the American College of Cardiology that works to reduce "door-to-balloon" times or heart attack response in hospitals across the world.  ---------By Linda Barlow, Genesis

Heart Attack Symptoms

If you think you're having a heart attack, call 911 immediately. These signs may mean a heart attack is in progress:

• Chest discomfort -- Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body -- Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath -- May occur with or without chest discomfort. Signs may also include breaking out in a cold sweat, nausea or lightheadedness.