Fast Care for Heart Attacks, Strokes

Hospitals in Missouri are setting up a system to let ambulances bypass closer hospitals for designated stroke and heart attack centers.


Blythe Bernhard | | Friday, May 15, 2009

ST. LOUIS -- To survive a heart attack or stroke, the most important factor is the clock. The risk of serious complications and death climbs precariously in the time it takes a patient to travel to a hospital and get treatment.

In Missouri, people die from heart disease and stroke at higher than average rates, both because of unhealthy lifestyles and lack of access to health care.

That's why hospital leaders and state health officials are working on a statewide system to get stroke and heart attack patients to the appropriate hospitals in the shortest amount of time. While advances in research have improved survival rates for heart attack and stroke, the treatments are still not available to everyone.

"It's very difficult to coordinate the universal access to care for everyone across the state regardless of where they live and how close they are to a hospital," said Dr. Richard Bach, director of the cardiac critical care unit at Barnes-Jewish Hospital.


A task force of about 140 leaders in emergency medicine met Tuesday in Columbia to continue planning the "Time Critical Diagnosis System" for heart attack and stroke created by a state law that passed one year ago.

Under the system, ambulances and medical helicopters could bypass closer hospitals for designated stroke and heart attack centers that are better suited for the most seriously ill patients.

It's modeled after the trauma system already in place and could be up and running by 2012. Missouri would likely become the first state to have an standardized emergency system for patients whose lives are most at risk - from trauma injuries, strokes and severe heart attacks.

Under the voluntary system, hospitals would be divided into four categories based on their staffing, capabilities and equipment. Hospitals could start applying for recognition by next year. It's estimated that fewer than half of Missouri's hospitals would qualify for the top designations in heart attack and stroke.

Planning the system is a "behemoth" undertaking, Bach said. Health care services are unevenly distributed across Missouri, where some rural areas still lack 911 service.

Under the new system, patients could be diagnosed with heart attacks or stroke in the field and bypass the emergency room for more critical care units, where doctors and surgeons would be waiting.

Today ambulances transport most patients to the closest hospital. In St. Louis County, the average trip to a hospital is four minutes, said Wayne Sanders, officer with West County EMS and Fire Protection District. But in rural areas, "it may take an hour to get to the person's house, another hour and a half to get to the hospital, and it really puts those folks at a disadvantage," Sanders said.

The new system isn't just about saving lives, but also saving money. Hospitalization, rehabilitation and lost productivity costs for heart disease and stroke cost the state more than $5 billion annually, according to the Missouri Department of Health and Senior Services.

Funding for the project comes to the state through grants from the federal Centers for Disease Control and Prevention and the nonprofit Missouri Foundation for Health.


Heart disease kills more people in Missouri and nationwide than any other cause of death. Stroke comes in at No. 3, after cancer. And residents here fare worse than the national averages in every risk factor for heart attack and stroke: high blood pressure, high cholesterol, lack of exercise, poor diet, smoking, obesity and diabetes.

As the health care community works to improve those outcomes, patients also need to take on some of the responsibility for timely treatment, doctors said. Too often, people think heart attack victims clutch their chests in excruciating pain, when often they feel more of a subtle pressure or fullness. Stroke symptoms can also be mild and include numbness on one side of the body and dizziness.

With strokes, the window for getting intravenous clot-busting drugs to the patient is just three hours or less before permanent brain damage can set in. Even if stroke patients get to the hospital in time, fewer than 5 percent get the drugs that are the standard of care because most hospitals are incapable or uncomfortable with using them.

Mortality with heart attacks is directly linked to the amount of time it takes a patient to get from the hospital doors to the operating table for an artery-opening angioplasty. Fewer than 40 percent of patients get an angioplasty within the recommended time frame of 90 minutes, according to the state health department.

The goal of the new system is to improve those results, said Michelle Miller, health policy associate at the Missouri Foundation for Health.

"The biggest impact is really on saving brain matter and saving muscle in the heart so that people are able to maintain their quality of life."

GETTING THE SYSTEM GOING For more information on the time critical diagnosis system,

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Related Topics: Cardiac and Circulation, Medical Emergencies

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