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N.J. system to move heart attack victims to best hospitals studied

Newark, N.J. When Gov. Jon Corzine suffered life-threatening injuries in a Garden State Parkway crash last month, emergency personnel bypassed closer hospitals to fly him to a Level I trauma center in Camden where they believed he would get optimal care.

New Jersey cardiac experts are now looking at creating a similar system for heart attack patients, saying they sometimes languish at hospitals lacking the resources to provide quick assessment and life-saving interventions like angioplasty.

The proposal, discussed yesterday during a New Brunswick conference, is bound to create controversy because it will also result in ambulances bypassing hospitals to get to a facility deemed more capable of treating heart attack patients.

“In the Governor’s (trauma) case, the risk of the extra time was deemed to be worth it,” said State Health Commissioner Fred Jacobs, referring to what he described as Corzine’s “miraculous” recovery at Camden’s Cooper University Hospital after breaking his left thigh, 11 ribs, collarbone and sternum.

Jacobs acknowledged that moving to a regional system of heart attack care will not be welcomed by all institutions. Cardiac care is a lucrative and highly competitive field in New Jersey and some hospitals could see a loss of revenue under such a plan.

“Cardiac care is important but does not exist in a vacuum and we can’t put general medical care at risk,” said Mark Zucker, president of the New Jersey Chapter of the American College of Cardiology, a conference co-sponsor.

Zucker’s group, representing the state’s 1,200 cardiologists, is already spearheading a program to reduce so-called “door-to-balloon time,” which refers to how long it takes an arriving heart attack patient to receive an angioplasty, a surgical technique in which a balloon is inserted into a blocked artery and inflated to help restore blood flow.

Under the system proposed yesterday, hospitals that qualify would be given designations of Level I, II and III, based on the level of care available to heart attack patients. Level I would be the highest designation and would be reserved for those hospitals – there are now 18 – with both on-site cardiac surgery and angioplasty capability.

A total of 42 New Jersey hospitals are licensed to provide emergency angioplasty, but don’t offer cardiac bypass surgery. These hospitals would be given designations of Level II or Level III, depending on factors like whether they perform angioplasty or have such services as a dedicated care unit for heart patients or around-the-clock anesthesia available.

“There are systems that work. We have the facilities and we have the manpower,” said Charles Dennis, chairman of Jacob’s Cardiovascular Health Advisory Panel and director of the catheterization lab at Virtua Memorial Hospital in Mt. Laurel.

He urged the cardiologists in attendance to lay aside turf issues to ensure patients get the best care.

The New Jersey proposal was reinforced yesterday by the American Heart Association, which announced its own grassroots initiative to improve access to angioplasty for heart attack patients.

Both association and New Jersey officials are targeting patients who suffer the worst and most easily recognizable type of heart attacks, known as STEMI, or ST-elevation myocardial infarction.

“New Jersey doesn’t now have a system per se,” said William A. Tansey 3d, a member of the board of directors of the American Heart Association and a cardiologist at Overlook Hospital in Summit. “I think this will happen at a very brisk pace now.”

Regional systems for heart attack care already are in place in areas of Maryland, Massachusetts, North Carolina, Pennsylvania and Minnesota.

A state-commissioned report due out soon will focus on where improvements can be made during the pre-hospital phase of care.

“If you can’t put the whole package together, from the patient’s perspective, then who cares?” said Harlan Krumholz, a Yale University professor of medicine, epidemiology and public health.