NCPA - National Center for Policy Analysis


August 30, 2005

Fewer than half of all heart attack patients in the United States are treated promptly enough to meet current guidelines for minimizing damage, says USA Today's Steve Sternberg.

The worst time to have a heart attack, says Sternberg, is after business hours or on weekends, especially if patients need an emergency angioplasty -- a procedure in which doctors guide a balloon-tipped wire to the site of the blockage and open the balloon to clear out the artery.

A study of 100,000 heart attacks logged into the National Registry of Myocardial Infarction from 1999 to 2004 found that all patients had blockages in arteries that supply the heart, not rhythm disturbances that can cause cardiac arrest, and that doctors attempted to reopen their clogged arteries with either clog-busting drugs or by emergency angioplasty.

  • Even though, angioplasty is more effective, clot-busters are used more often since angioplasty must be done in a high-tech catheter lab by trained personnel.
  • About 20 percent of hospitals can handle emergency angioplasty, which was used on 33,647 patients and about 50 percent of those whose heart attacks occurred during business hours were treated within 90 minutes -- the timeline set by the American Heart Association; only 25 percent were treated after hours.
  • However, a total of 68,439 patients were given clot-busters; about 45 percent were treated within 30 minutes during business hours and 40 percent of those who arrived after hours were treated within 30 minutes.

Overall, after hours delays were much shorter for patients who were treated with drugs than for those treated with angioplasty; during business hours, clot-busters were given within 33 minutes and within 44 minutes after hours while the "door to balloon" time rose from 95 minutes during business hours to116 minutes after hours, says Sternberg.

Source: Steve Sternberg, "Prompt heart attack response falls short," USA Today, August 16, 2005.

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