HealthWatch: Heart Attack: Slashing Door-to-Balloon Times

CLEVELAND, Ohio. (Ivanhoe Newswire) — Each year, about 250,000 Americans suffer from the most severe type of heart attack. Getting them treatment quickly is the key to a better outcome. Now there’s a novel way to cut the time it takes to get heart attack patients life-saving care. 
When a heart attack happens, each passing minute could mean the difference between life and death. 
The goal is to get patients treatment and fast. It’s what hospitals call door-to-balloon time. 
Travis Gullett, M.D., an emergency physician at Cleveland Clinic explained, “Door-to-balloon time basically takes the time you hit the front door of the hospital to the time the device in the heart is actually opening up the blood flow.”
Umesh N. Khot, M.D., a cardiologist also at the Cleveland Clinic, told Ivanhoe, “By removing that clot as soon as possible, then the heart can come back.”
National guidelines suggest door-to-balloon times should be 90 minutes or less for the most severe type of heart attack, known as a STEMI. Doctors at the Cleveland Clinic have been able to cut those times dramatically. 
“Now, our current median time is 49 minutes,” detailed Dr. Gullett
The Cleveland Clinic’s protocol standardizes criteria for the entire treatment team, including nurses, doctors, paramedics, and pharmacists. There’s a detailed checklist for everyone involved with the patient’s care and door-to-balloon times are posted daily. 
Dr. Gullett said, “That really gives us a marker for how well we’re doing as a system.”
In the first year, 100 percent of the heart attack patients were treated within the recommended 90 minutes. Thirty-five percent of patients had door-to-balloon times of 45 minutes or less. Many were treated in as little as 21 minutes. 
“I think it’s really changed the natural history of these types of heart attacks,” Dr. Knot told Ivanhoe.  
It’s a system that’s saving hearts, and saving lives. 
Cleveland clinic doctors hope to publish results of how their protocol is specifically impacting death rates soon. Their new door-to-balloon goal is now 45 minutes. Hospitals from around the world have contacted these doctors, asking them how they can implement similar systems.
Contributors to this news report include: Cyndy McGrath, Supervising Producer; Julie Marks, Field Producer; Milvionne Chery, Assistant Producer; Roque Correa, Editor.
TOPIC:       Heart Attack: Slashing Door-To-Balloon Times
REPORT:   MB #4218
BACKGROUND: A heart attack is an event that occurs when the blood flow that transmits oxygen to the heart is severely reduced or stopped completely. One reason for this blood flow to become reduced is because of the blockage of an artery due to fat, cholesterol or plaque. About every 43 seconds, a person in America suffers from a heart attack. The most common symptoms of a heart attack are the following:
* Chest discomfort, including uncomfortable pressure, squeezing or pain in the chest that lasts more than a few minutes, or that goes away and later comes back.
* Discomfort in other areas of the body, including pain in the arms, back, neck, jaw or stomach.
* Shortness of breath.
* Cold sweat, nausea and lightheadedness 
The most common symptom in men is chest pain, whereas women are more likely to experience shortness of breath, vomiting and pain in other parts of the body.  
ACTING FAST: Heart attacks are very delicate events, and in order to overcome them it is important to act fast. If you think you are suffering from a heart attack it is important to call 911 immediately in order to be treated as soon as possible in a hospital with treatments like balloon angioplasty, clot-dissolving drugs, surgery and/or a combination of all of the above.  
DOOR-TO-BALLOON: In order to save lives it is not only important that the patient acts fast, but the hospital does as well; every minute matters. Normally, severe heart attacks like a STEMI are treated with a door-to-balloon protocol. Door-to-balloon is the time that elapses from when a patient enters the door of the hospital to the time blood flow is circulating to heart again. The American College of Cardiology suggests that this time should be 90 minutes or less. In order for these times to be achieved it is important that everyone involved is working consistently and together; this includes doctors, nurses, paramedics, and pharmacists. There is a checklist these professionals have to follow and the data of each patient is posted daily. The Cleveland Clinic has been able to cut the door-to-balloon time almost in half. Thirty-five percent of their patients have had door-to-balloon times of 45 minutes or less and others were able to be treated in only 21 minutes. Researchers will soon publish the results of how their protocol reduces the overall time and how it is specifically impacting death rates.  
(Source: Dr. Travis Gullet & 
Andrea Pacetti       
If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at

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