Friday, August 3, 2007

Are new laws needed to designate hospitals that perform angioplasty?

Studies have shown that one of the best treatments for patients who are having a heart attack where their blood supply is blocked for a prolonged period of time (ST-elevation myocardial infarction) is to have an angioplasty within 90 minutes of the heart attack. Angioplasty is a procedure that opens blocked arteries using a catheter-guided balloon.

But not all hospitals are equipped to perform angioplasty, and patients don’t always get to a treatment center within the ideal, but narrow, timeframe when an angioplasty would be most beneficial.

Law professor Robert Steinbuch (of the University of Arkansas in Little Rock) wants new laws that would direct emergency personnel to bring patients with suspected heart attacks to the nearest hospital that can perform angioplasty, and not just the closest hospital or emergency room.

Steinbuch, who is also on the board of the Society of Chest Pain Centers, also wants laws in place where only facilities that can perform angioplasty as part of heart attack treatment can designate themselves as chest pain centers. This designation, he believes, may help those patients with heart attack symptoms who drive themselves to a treatment center better understand the differences between facilities.

Facilities that don’t perform angioplasty or can’t perform it in time will often treat patients with fibrinolysis – the administration of a fibrinolytic drug to break up the blood clots that are blocking the arteries to the heart.

The DCRI’s Chris Granger, MD, is one of the cardiology experts who disagrees to some extent with Steinbuch’s recommendations. Granger has been working to improve heart attack treatment in North Carolina and does believe angioplasty should be more widely performed because of the lower risk of bleeding complications.

One of Granger’s concerns with Steinbuch’s recommendations is that patients often don’t seek treatment for heart attack fast enough for angioplasty to be effective. Many other patients will drive themselves to the hospital, instead of calling 911. If they are having a heart attack, taking a few extra minutes to drive to a hospital that can perform angioplasty could be life-threatening. He said it is important to take a closer look at the impact of sending all patients to hospitals with angioplasty capabilities to see if it will lead to better outcomes.

Granger, however, does believe that if a patient has called for an ambulance, going to a hospital that is slightly farther away but capable of performing angioplasty might be reasonable. This is because paramedics could use a defibrillator if the patient’s heart stops.

Granger also believes that fibrinolysis is still an effective way to treat heart attacks, especially for patients with low risk of bleeding complications. He said the most important thing is to get blood flowing to the heart quickly, whether that is through angioplasty or fibrinolysis.

This is an issue that is hotly debated on all sides, and one which some doctors, Granger included, think should be addressed on a regional scale before broader-scope laws could become a reality.