February 14, 2005

Expert Commentary:
Time of the Essence When Transferring Heart Attack Patients Between Hospitals

(Philadelphia, PA) – In an editorial in the February 15th issue of Circulation, Howard C. Herrmann, MD, Director of Interventional Cardiology & the Cardiac Catheterization Laboratory at the Hospital of the University of Pennsylvania, notes time is a critical factor in determining the risk/benefit to heart-attack patients when transferring them to a hospital that can perform angioplasty (surgical repair of a blood vessel). Indeed, should these patients, who present with acute ST-elevation myocardial infraction (STEMI), be routinely transferred from hospitals without a catheterization lab to facilities equipped with one to perform immediate angioplasty rather than receive medical therapy at the initial hospital?

Several recent trials have concluded that angioplasty is better than fibrinolysis (the process of breaking up and dissolving blood clots using medications) in treating acute STEMI patients, and that even with an added transfer time to another hospital, it still retains an advantage.

However, in this issue of Circulation, a 2005 study (Nallamothu et al.) evaluated transfer times of more than 4,200 patients and found that there was an average delay time of 180 minutes from the time a patient presented at a hospital to the time they underwent angioplasty after transfer to another facility capable of immediate angioplasty, also know as door-to-balloon time. This is double the recommended amount of time – 90 minutes – from presentation to catheterization, according to American College of Cardiology/American Heart Association guidelines.

“These time delays are dramatic and could mean the difference between life and death for some of these patients,” says Dr. Herrmann. “That’s why it is too early to recommend routine transfers for primary angioplasties for all patients presenting with STEMI, until protocols are put in place to ensure rapid transfer times.”

Dr. Herrmann suggests putting into place common practices already performed in some European countries and in isolated areas in the U.S. These practices include: better identifying those patients who would benefit most from transfer, optimizing communication systems to include early mobilization of the cardiac catheterization team in the transfer hospital, minimizing delays on arrival at the transfer hospitals to the catheterization laboratory, and possibly creating specialized centers utilizing the latest advanced therapies.

“Although the rapid performance of angioplasty may be the best treatment for most patients with acute MI, delays in its application may make alternatives, including thrombolysis, a better choice for some patients,” adds Dr. Herrmann.

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Editor’s Notes: Dr. Herrmann is available for interviews on this position.

The University of Pennsylvania has an on-campus television studio with satellite uplink, live-shot capability for interviews with Penn experts.

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This release is available online at http://www.uphs.upenn.edu/news/News_Releases/feb05/HerrmannEC.htm