"911 to cath lab in under 90 minutes" is the motto for an Emory University trial program being offered to City of Atlanta residents who experience symptoms of a heart attack and call 911 for help.
The Emory/Grady Heart Attack Rescue Team or "HART" study is a highly coordinated emergency cardiac care delivery system, which involves assessing patients in the field, transmitting an EKG to an emergency medicine physician, and then quickly transporting the patient to a hospital capable of performing immediate coronary angioplasty -- 24 hours-a-day, 7 days-a-week. Angioplasty is a medical procedure in which a balloon is used to open narrowed or blocked blood vessels of the heart. The treatment has scientifically been proven to save more lives.
"Studies have shown that coronary angioplasty is superior to administering clot-dissolving drugs when trying to prevent permanent damage to the heart after a heart attack," says Bryan McNally, MD, MPH, an assistant professor of emergency medicine, Emory University School of Medicine. "We believe this initiative will change the way heart attack victims are treated in the community and eventually throughout Georgia and the rest of the nation."
Through HART, Grady EMS paramedics - who already respond to all 911 calls in the City of Atlanta and Central Fulton County - will acquire 12-lead EKGs (electrical tracings of the heart) and transmit this information to an emergency physician in the Emergency Department of either Emory University Hospital (EUH) or Emory Crawford Long Hospital (ECLH). If the EKG reveals that the patient is having a heart attack, he/she will be offered the option of immediate transport to the cardiac catheterization lab at EUH or ECLH for evaluation by a cardiologist capable of immediately performing angioplasty.
Participation in HART is voluntary. If patients choose not to be transported to EUH or ECLH, Grady EMS will take them to the hospital of their choice for standard evaluation and treatment (most likely with a clot-dissolving drug).
"When a person has a heart attack, his or her odds of surviving shouldn't be at the mercy of chance and geography," says Douglas Morris, MD, director of the Emory Heart Center and J. Willis Hurst professor of medicine in Emory's Division of Cardiology. "But several recent studies have suggested that's what happens when people with heart attacks end up at a facility that does not offer angioplasty, simply because it was the closest place for the ambulance to take them. The HART project is designed to overcome this obstacle by coordinating care between the ambulance, hospital emergency department staff and treating cardiologists to make sure those who suffer a heart attack get the best and quickest treatment possible."
Dr. Morris has been instrumental in planning this project.
A heart attack is caused by the blockage of one or more of the coronary arteries that supply blood to the heart. It is a dangerous condition that can cause permanent damage or death. Restoring blood flow to the blocked arteries as quickly as possible is imperative. The two main options to restore blood flow are administration of a clot-dissolving drug, or emergency angioplasty. Studies show that emergency angioplasty generally restores blood flow faster and better than clot-dissolving drugs and results in a higher rate of survival and lower risk of stroke. Also, angioplasty does not present the same risk of dangerous bleeding that may occur with clot-dissolving medication.
"HART is a proof-of-concept pilot program designed to demonstrate the feasibility of identifying patients in the field who are experiencing a heart attack and transporting them to specialized hospitals for care," says Arthur Kellermann, MD, MPH, professor and chair of emergency medicine at Emory.