Heart attack? Get to the Hospital Quickly!

When a heart attack strikes, the absence of oxygen-containing blood damages and kills heart muscle cells.

As you might expect, as the time of blockage lengthens, the more cell damage and cell death occurs. Heart muscle can be saved from destruction, however, through rapid restoration of blood flow (reperfusion). This is possible by reopening occluded arteries with a balloon (angioplasty) or bypassing them (coronary artery bypass surgery). The key is getting this done quickly. Let's look at why time is so important.

Guidelines from the ACC and the AHA

Guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend that no longer than 90 minutes elapse from the time that a heart attack patient arrives at a hospital and reperfusion therapy is begun (referred to as door-to-balloon or DTB time). Hospitals around the country have worked hard to provide the personnel and equipment around the clock to comply with these guidelines. The capacity to meet the recommendation is used nationally as an indicator of hospital quality.

Less than 90 minutes DTB time may not be helpful

A report in a recent issue of Archives of Internal Medicine examined whether improvement in DBT time reduced mortality from an acute ST-elevation heart attack (STEMI) at a group of Michigan hospitals. The results were disappointing. Even though the DTB time decreased from 113 minutes in 2003 to 76 minutes in 2008, and the percentage of patients who received therapy in less than 90 minutes more than doubled, there was no change in hospital mortality during this period. The authors do not reach this conclusion in their discussion of the results, but it seems obvious that the best efforts of hospitals are largely wasted if considerable heart damage occurs during the delay between the beginning of a heart attack and the arrival of patients at a prepared hospital.

Getting to the hospital more quickly is critical

Earlier studies have documented an average delay of two hours between the onset of symptoms and presentation at a hospital for patients with STEMI heart attacks. And these delay times have not decreased despite extensive public education efforts. Another article in the same issue of the Archives of Internal Medicine examined how long it took patients with a less severe type of heart attack (non-STEMI) to get to a hospital. Hospital records of over 100,000 patients showed that 60 percent of them waited for more than two hours after the onset of symptoms before they began to seek medical care.  

Call 911 if you have heart attack symptoms

Since heart attack victims are unable to tell whether they are having a more or less severe heart attack, it is critical for all people to follow the recommendations of the American Heart Association: call 911 if symptoms of a heart attack are unchanged or worsen after 5 minutes. ALL older men and women, but especially those diagnosed with coronary heart disease, should know the symptoms of a heart attack. 

Visit the American Heart Association website to learn specifics about the symptoms of a heart attack and how they can differ for men and women.