HARRISBURG, Pa.-- After surviving a heart attack, you might return to work and do pretty much what you did before.
Or your productive days could be over, with the rest of your life dictated by illness and disability.
How you wind up might depend on how fast the people at the hospital thread a tiny balloon into your blocked artery and break the clog that caused your heart attack.
It's called balloon angioplasty.
Whether you get it soon enough depends on the performance of many people -- from the ambulance crew to the emergency room staff to the team that performs the procedure in a catherization lab.
People who receive one within 90 minutes of arriving at the hospital are much better off.
Yet only 40 percent of U.S. hospitals consistently deliver it that quickly, according to the American College of Cardiology.
In Pennsylvania, there's a new effort to make sure everyone gets it fast enough.
About 200 people statewide met recently at Penn State Milton S. Hershey Medical Center to share information about "door-to-balloon" time, or the time it takes from when a patient arrives at the hospital until when the balloon is inserted.
The next step in the state effort is a task force that will work to standardize methods throughout Pennsylvania.
Many factors affect how quickly a patient gets the procedure, says Dr. Steven Ettinger, a Hershey Medical Center cardiologist.
Hospitals vary in their knowledge and methods for carrying it out.
Delivering it within 90 minutes requires a flawless system for quickly summoning a cardiologist and other specialized staff, especially at night and on weekends.
Delays can stem from poor communication or poor cooperation between the emergency room and the staff at the catherization lab.
While doctors can gain a valuable head start if the ambulance crew transmits EGK data to the hospital, not all ambulance companies are equipped for it.
Health insurers also play a role, because their willingness to pay for services and equipment can impact quality, Ettinger says.
Door-to-balloon time is critical because heart muscle dies until the blockage is removed. Dead heart muscle is lost for good.
People who lose too much heart muscle are left with problems such as congestive heart failure, Ettinger says.
Until hospitals began focusing on door-to-balloon times a few years ago, it often took more than three hours, says Dr. Michael Madden, who directs medical performance programs for Highmark Inc.
Highmark wants all hospitals offering balloon angioplasty to measure their door-to-balloon times and try to streamline the process, Madden says.
Madden advises people who live near more than one hospital to find out which one has focused on door-to-balloon time. That's where they should ask to go if they have a heart attack.
Highmark was a sponsor of the recent door-to-balloon conference.
Health insurers have a stake because, if a heart attack patient doesn't get the best care up front, their long-term medical costs will be higher.
Pennsylvania's effort is noteworthy in that it involves everyone in the process -- hospital administrators, emergency room doctors, the catherization lab team, ambulance crews and health insurers, Ettinger says.
It's also noteworthy because it breaks down traditional barriers that have limited the sharing of medical information, he says.
At hospitals, we have often "bashed" other hospitals and "pounded our chests" over our own achievements, rather than share information or admit another organization might know more, he says.
Even within hospitals, there have been barriers among professionals and departments, he says.
Organizations including the American Heart Association and the American College of Cardiology are involved in the state effort.
Leadership from such organizations helps people ignore barriers that have hampered cooperation and sharing of information, Ettinger says.DAVID WENNER: 255-8172 or firstname.lastname@example.org