Press releases

Yale-New Haven Hospital news release
Release date: Nov. 28, 2006
Media contact: Mark D’Antonio, (203) 688-2493

Yale-New Haven Hospital: leading the charge in time-saving measures for heart attack patients

NEW HAVEN — Yale-New Haven Hospital (YNHH) is leading the charge in a country-wide hospital effort to reduce the time it takes to deliver emergency angioplasty, the “door-to-balloon time” from arrival in the emergency department to angioplasty for patients experiencing a heart attack.

YNHH has assumed a leadership role in the delivery of reliable, evidence-based care for heart attacks and consistently ranks in the 90th percentile in publicly-reported Centers for Medicare and Medicaid Services measures of care for heart attacks.

“Angioplasty is the best emergency treatment for a common type of heart attack, if delivered in a timely way,” said cardiologist Henry Cabin, M.D., medical director of the Yale-New Haven Hospital Heart Center and its coronary care unit. “At Yale-New Haven Hospital, rapid time-to-treatment is a priority. The sooner the blocked artery that causes the heart attack is reopened, the less heart muscle dies, and the faster and more complete the patient’s recovery.”

YNHH is participating in the national heart care initiative “Door-to-Balloon (D2B): An Alliance for Quality” campaign. The D2B program, launched this month, by the American College of Cardiology and the American Heart Association, is aimed at improving the timeliness of lifesaving therapy for patients with heart attacks at the nation’s hospitals that perform emergency angioplasty. Patients who receive prompt treatment are more likely to survive a common type of heart attack called ST-elevation myocardial infarction (STEMI).

“Angioplasty is most effective when performed in hospitals that make it the first-line treatment for these heart attacks, rather than at centers where it is not the leading form of heart attack care,” said Dr. Cabin.

“Many of the strategies that have been identified by the D2B campaign are modeled after Yale-New Haven,” said cardiologist Jaime Gerber, M.D., director of quality for the Yale-New Haven Hospital Heart Center. “It takes strong commitment by the senior leadership of the hospital to break down barriers in traditional care.”

“In YNHH’s ED, our treatment of acute myocardial infarction (MI), or destruction of heart tissue resulting from obstruction of the blood supply to the heart muscle, is 100 percent geared toward getting the patient and the catheterization lab team together as quickly as possible,” Dr. Cabin said. “We made the decision years ago that we would rely on angioplasty, 24 hours a day, seven days a week, to open blocked arteries and we have designed our systems around that goal. The median D2B time – from when the patient enters Yale-New Haven’s ED to the moment that the artery is cleared by balloon dilation in the catheterization lab — is 85 minutes, well within the American Heart Association’s recommended standard of 90 minutes.”

To achieve the treatment goal of less than 90 minutes — no more than 50 minutes in the ED and 40 minutes to perform the angioplasty — the YNHH emergency team follows a strict protocol that assures rapid diagnosis and transport to the catheterization lab for this lifesaving procedure.

The strategies in the D2B initiative, which are supported by research in the November 13th issue of the New England Journal of Medicine (NEJM), draws on research led by Elizabeth Bradley, professor of public health at the Yale University School of Medicine and Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at YNHH and the Hines Professor Medicine at Yale University School of Medicine and others who have identified hospitals that were consistently treating patients within the guideline-recommended 90 minutes and have been interviewing staff at those hospitals to find out what factors were essential to trimming down the delay between the arrival of a STEMI patient at the emergency department and the reopening of the infarct vessel. In addition to Bradley and Krumholz, the multidisciplinary team of authors on the NEJM article included Janet Parkosewich, R.N., M.S.N., cardiac clinical nurse specialist at YNHH.

The six core strategies of the D2B campaign include having emergency medicine physicians activate the catheterization lab; having a single call to a central page operator activate the lab; having organizational expectations that the cath team will arrive in the catheterization lab within 20 minutes after being paged; having strong administrative support for the program, using a team-based approach; and having real-time data feedback for staff in the ED and cath lab.

Said Dr. Cabin on the D2B campaign’s recommended initiatives: “We were early adopters of many of these strategies at Yale-New Haven, and have been consistently among the top performers in the timeliness of emergency angioplasty for STEMI.”

Yale New Haven Hospital ranks among the top five sites for door-to-balloon times in the National Registry of Myocardial Infarction.

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Last revised: Nov. 29, 2006 (dh)

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