MGH Team Exceeds National Standard For Quick Response To Heart Attacks

But Many Marin Residents Wait Too Long Before Seeking Medical Help

Heart attack patients arriving at Marin General Hospital’s Emergency Department are more than twice as likely to receive emergency angioplasty within the optimal 90 minute time period than patients at the average hospital in California or the nation, according to a new national report.

Cardiologist Dr. Joel Sklar, medical director of the Marin Heart Institute at Marin General Hospital, said, “This may contribute to the outstanding mortality rate at MGH that is approximately half that of similar hospitals.”

The American College of Cardiology and the American Heart Association guidelines state that the national standard for ‘door to dilation time’ (first arrival at the ED to initial angioplasty treatment) should be 90 minutes or less.

According to the National Registry of Myocardial Infarction (NRMI) “MGH was able to get 80 percent of its patients into the angioplasty suite (the Cardiac Catheterization Laboratory) and get the blocked coronary artery open within 90 minutes,” Sklar said. “However, NRMI reported only 30 to 35 percent of patients in California and nationwide received angioplasty treatment that fast.”

Marin General treated 214 heart attack patients last year, according to the NRMI report, with 175 arriving at the Emergency Department and 39 transferring from other hospitals. Of the non-transferred patients, 35 were treated by emergency angioplasty in the MGH Cath Lab.

“The patients who were eligible for emergency treatment to open the artery had a mortality rate of only 1.6 percent,” he said, “while the mortality rate for all non-transferred patients was 5.7 percent. This compares with a mortality rate of from 9.2 percent to 10.1 percent at similar sized hospitals in California and the nation.”

Emergency Angioplasty Only Available At MGH

Emergency angioplasty is available in Marin only at the hospital’s Cath Lab, which provides the service 24 hours a day, seven days a week by an on-call team of cardiologists and staff. Patients from Novato
Community Hospital are also treated there.

Not all heart attack patients require emergency angioplasty. That decision is based on each patient’s clinical situation, but Marin General was able to treat a higher percentage of patients with angioplasty than most other hospitals, according to the NRMI report.

Sklar said the reason a community hospital like MGH can achieve these results is because of the quick response by the medical team.

“We have a small, motivated and dedicated team of ED physicians, cardiologists and Cath Lab staff that give high priority to heart attack patients,” Sklar said. “Our state of the art equipment is a big help but, more than that, it’s our team’s willingness and commitment to make things work that helps us to achieve such excellent results.”

Some Marin Residents Wait Too Long Before Seeking Help

The NRMI data also showed that many Marin residents wait longer than the national average to seek medical help at the onset of symptoms. The quicker a patient dials 911 and is rushed to the hospital, the better the odds are for receiving the best and most effective treatment.

“Marinites seem to wait significantly longer before arriving at the ED for treatment of their heart attacks,” Sklar said.

It took patients eligible for emergency angioplasty, who were transported directly to MGH from their home, an average of 125 minutes from the onset of symptoms to arrival at the ED, the report said. The lapse time was about 90 minutes in similar sized hospitals.

Ideally, patients should arrive at the ED as soon as possible after the first signs of a heart attack.

Sklar said, “Sure, a heart attack victim can arrive at our ED, be diagnosed and sent to the Cath Lab for treatment within 60 minutes. But, if he waited two hours to call the paramedics he may have lost much of the benefit of what we can do. Heart muscle cells start dying the minute the blood flow is cut off and, every bit of heart muscle counts.

“If our patients take 125 minutes to get to the ED, but in other communities they take 90 minutes, this difference of 35 minutes is significant. Those 35 minutes may make the difference between a big heart attack and a little heart attack.”

It may also make the difference between living and dying, or living with long term problems like congestive heart failure, he said. “The more time an artery is blocked, the more heart damage there is. So, the sooner you get angioplasty to unblock the artery, the less heart damage there is likely to be.”

Angioplasty More Effective Than Clot Busters

However, Sklar said it is better to wait several hours for emergency angioplasty than to wait one hour for clot dissolving drugs.

“We’ve been using emergency angioplasty to treat heart attacks patients since April 1999 and many studies now confirm that the procedure is superior to clot dissolving drugs,” Sklar said.

Many studies confirm the superiority of opening clogged arteries with balloons and other devices as
the initial therapy rather using than clot-dissolving drugs like tissue plasminogen activator, or TPA.

A person having a heart attack may experience some or all of the following:
  1. Pressure, fullness discomfort or squeezing in the center of the chest. It lasts for more than a few minutes or goes away and returns

  2. Pain that goes to your shoulders, neck or arms

  3. Sweating, discomfort in the chest, lightheadedness, faint, upset stomach or shortness of breath
Women, however, may not often experience such symptoms and may often only notice weakness, nausea, heartburn or other less obvious signs. They and their doctors need to be extra alert to the possibility of heart attack.

June 9, 2003