New Cardiology Methods Saving Lives

Showtime · Nov 11, 2007

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When Enorio Branco had crushing chest pain last year, paramedics knew they should bypass the emergency room and rush him straight to a catheterization lab to have a blocked artery cleared immediately. That's because ambulances run by University Hospital in Newark send a cardiologist a full electrocardiogram on each patient with chest pain as they speed to the hospital.

The cardiologist determines whether the patient is having a heart attack and needs artery-clearing angioplasty right away. If so, a team of doctors and nurses is alerted or on nights and weekends told to rush to the hospital to perform angioplasty, in which an inflatable catheter is inserted in an artery to press it open. The system has halved ''door-to-balloon time,'' the period between a patient's arrival and his surgery, at University Hospital. The program aims to keep that period under 90 minutes for 75 percent of patients, up from about 30 percent.

Branco, 52, of Newark, suffered his heart attack a month after the project began. As a result of the electrocardiogram sent to the hospital from the ambulance, his blocked artery was opened barely 30 minutes after he reached the hospital. ''I'm 100 percent now,'' the leather processing worker said. ''One of the Holy Grails within cardiology is to shorten as much as possible the door-to-balloon time,'' said Dr. Marc Klapholz, the hospital's director of cardiology.

The hospital's system, begun in June 2006, is part of a nationwide trend of hospitals trying to stop heart attacks as quickly as possible, saving lives and limiting damage. The American College of Cardiology and the American Heart Association launched what they called the D2B Alliance last November, and more than 900 U.S. hospitals have joined, including more than two-thirds of those that provide angioplasty, Yale University cardiologist Dr. Harlan Krumholz said Tuesday.

Hospitals and ambulance companies use a wide variety of systems to transmit information on the fly. Some of the technology has been around for as long as 10 years. But it was rarely used, said Dr. Henry Ting, a Mayo Clinic cardiologist, and many bugs remain, such as technologies that don't work together and the lack of reliable cellular coverage in many areas.

Southern California has both problems. Paramedics who work in four counties, from San Diego to Los Angeles, must cope with dodgy cell coverage in the hilly areas and multiple ambulance services that use different brands of portable EKG machines and different wireless transmission technology and hospitals that don't subscribe to all possible combinations, said Dr. Ivan Rokos, a UCLA Medical Center emergency physician.

''Wireless is the future, but it's not perfect yet,'' he said. To get around those problems, the medical center has trained paramedics to interpret electrocardiograms the readouts of spikes and valley showing heart electrical activity and decide whether to alert a cath lab to get ready, Rokos said. Ting said the Mayo Clinic, serving mostly rural Minnesota, has done the same thing. The UCLA hospitals also have begun using camera phones to send a photo of the EKG readout, but Newark's Klapholz said sending cardiologists a computer file of the EKG is preferable because it shows them more and allows them to zoom in and out.

Other hospitals and ambulance services are testing other approaches, including faxing EKG images to the hospital. Dr. Jacob Shani, director of cardiology at Maimonides Medical Center in Brooklyn, N.Y., got one faxed from a shopping mall where a man had collapsed. Klapholz, an associate professor at University of Medicine and Dentistry of New Jersey, said his research shows University Hospital has cut its average door-to-balloon time from 146 minutes in 2005 to 74 minutes from June 2006 through September 2007.

Yale's Krumholz said the goal of stopping the worst heart attacks within 90 minutes was considered unattainable a half-dozen years ago, while some are now stopped within 30 minutes. ''I just can't tell you what it feels like to have someone come in who's having a life-threatening heart attack,'' he said. ''And because the system works right, they leave the hospital as if nothing happened.''
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