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Hospital transfers too slow for heart patients

YALE (US) — Most heart attack patients transferred between hospitals for angioplasty are not moved as quickly as they should be, according to the first national study of “door-in door-out” transfer time.

Fewer than 10 percent of heart attack patients transferred from their initial hospital to one offering the life-saving procedure are transferred within the recommended 30 minutes, according to the study published in the Archives of Internal Medicine.

For ST-segment elevation myocardial infarction (STEMI) patients, quick response is critical because that type of heart attack is caused by a complete blockage of blood supply to the heart.


Angioplasty should be performed as quickly as possible, but many smaller hospitals don’t have the staff or facilities to perform the procedure around the clock, and it’s recommended that those patients be sent to a hospital that offers the procedure. The time from arrival at the first hospital until the patient leaves should be no more than 30 minutes, according to the guidelines.

“This represents a large and avoidable increase in risk of death for these patients,” says lead author Jeph Herrin, assistant adjunct professor of cardiology at Yale University.

“Numerous studies have shown that even a few minutes delay in receiving angioplasty increases the risk of death for STEMI patients. Among this group are thousands of patients that are delayed more than an hour from what is recommended.”

Herrin and co-authors analyzed nationwide data collected by the Centers for Medicare & Medicaid Services on all heart attack patients with STEMI who were transferred explicitly for angioplasty during 2009, including patients who were not covered by Medicare. If a hospital transferred fewer than five patients, its data wasn’t included.

In 2009, nearly 14,000 heart attack patients were transferred from smaller hospitals to hospitals that offer angioplasty, but fewer than 10 percent of them were sent onto the second hospital within the recommended time. Nearly one third of the heart attack patients were sent more than 90 minutes after arriving at the emergency room.

“We have made such great strides in reducing the time to treatment for those patients who are admitted to hospitals with angioplasty facilities; our next big challenge is to be sure that we reduce delays for patients who are transferred,” says senior author Harlan Krumholz, professor of medicine (cardiology) at Yale.

The study was funded by the Centers for Medicare & Medicaid Services.

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