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A joint release of the University of Michigan Health System, Blue Cross Blue Shield of Michigan, and Michigan Chapter - American College of Cardiology"

February 2, 2007

Faster heart-attack care coming to Michigan hospitals

More than 35 hospitals, led by U-M, BCBSM and Michigan Chapter ACC, team up to speed emergency angioplasty and give patients a better chance

ANN ARBOR, MI – Michigan residents who suffer heart attacks will get faster treatment with the most effective emergency heart procedures, under a new multi-hospital initiative being launched in Michigan this week. And the speedier treatment will give them a better shot at survival and long-term health.

Mauro Moscucci, M.D.Representatives from more than 35 hospitals will gather today in Ann Arbor for a day-long meeting to kick off a new statewide project coordinated by the Michigan Chapter of the American College of Cardiology and the University of Michigan Cardiovascular Center with support from Blue Cross Blue Shield of Michigan/Blue Care Network.   

Their main goal: to reduce the time it takes to deliver heart-attack care — from the minute a patient arrives at the emergency room to the minute when doctors inflate a tiny balloon to re-open the blocked arteries that cause most heart attacks.

“Every minute that can be saved is critical, because it keeps a bit of the patient’s heart muscle from dying or being weakened by lack of oxygen,” says U-M’s Mauro Moscucci, M.D., who will help lead the project. “In other words, time is muscle.”

BCBSMichigan“This is an example of a health plan, hospitals and doctors working together to make our state a national leader in improving the quality and efficiency of heart attack care,” says Thomas Simmer, M.D., BCBSM senior vice president and chief medical officer.

Studies have shown that patients who get the treatment — called angioplasty — within 90 minutes of arriving at the hospital have the best chance of surviving, and lower chances of long-term effects from their heart attack. Because angioplasty is performed using a tiny balloon, experts often refer to the time leading up to treatment as “door to balloon time” or D2B time.

The Michigan project is part of the American College of Cardiology’s national campaign called “Door to Balloon: An Alliance for Quality.” Many other health organizations including The American Heart Association are project partners. 

Michigan has a jump-start on the national effort because of previous statewide efforts to help hospitals improve other aspects of heart care, and D2B times. Under the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) led by Moscucci and BCBSM’s David Share, M.D., and coordinated by Eva Kline-Rogers, RN, MS, a group of 17 Michigan hospitals have been working to improve their angioplasty practices. Most of them will be represented at today’s event.

Last year, 12 of the BMC2 hospitals took part in a controlled pilot study that tested specific ways of shortening D2B time, and found progressive improvement. Michigan is already ahead of the national curve on D2B times, though its hospitals still have room for improvement. Current Medicare data show that 71 percent of Michigan heart attack patients get their angioplasty within 120 minutes of arrival – far better than the national average of 56 percent.

Michigan Chapter of the American College of Cardiology“Getting to 90 minutes for 75 percent of patients will require paramedics, emergency medicine doctors and nurses, cardiology doctors and nurses, angioplasty teams, and hospital administrators to make changes in the way they do things and approach patients,” says Stuart Winston, D.O., president of the Michigan Chapter of the American College of Cardiology and medical director of the Michigan Heart & Vascular Institute at St. Joseph Mercy Hospital in Ann Arbor.

The national and Michigan efforts are both aiming to get D2B time down to 90 minutes or less for at least 75 percent of patients experiencing the most common type of heart attack, called STEMI for ST-elevated myocardial infarction. Only STEMI patients have been shown to receive more benefit from emergency angioplasty — which is also known as primary percutaneous coronary intervention or primary PCI — than from fibrinolytic (clot-busting) drugs that can be given at most hospitals.

STEMI can be diagnosed in some ambulances, or shortly after arrival at the hospital, using a test called an electrocardiogram. But changing the process for triaging and diagnosing patients, and the actions that occur after diagnosis, affects everything from a hospital’s emergency room setup to the way it staffs its cardiac catheterization laboratory, or “cath lab”, where angioplasties are performed.

Today’s symposium will help doctors, nurses, administrators and other “quality champions” from each hospital learn some of the strategies that have worked for hospitals where D2B time has dropped. The event will also equip them with tools for making change happen at their hospitals.

Several Michigan heart specialists – from the U-M Cardiovascular Center, Henry Ford Health System and Oakwood Hospital – were on national committees that helped develop the materials that are being used not only in Michigan but nationwide. The D2B toolkit, available online at www.d2balliance.org, includes detailed information on how to change everything from the way the cath lab is activated, to the way data on D2B times is shared with team members.

In addition to BMC2 and D2B, many of the hospitals coming to today’s meeting have also participated in an ACC initiative to improve non-emergency in-hospital care for heart attack patients. Called the Guidelines Applied in Practice, it was coordinated by U-M Cardiovascular Center director Kim Eagle, M.D., and project director Cecelia Montoye, RN, MSN, CPHQ. Moscucci and Eagle also recently wrote an editorial in the New England Journal of Medicine on the D2B time issue.  

Now, the participating hospitals will begin to make the changes that will help them reduce their D2B times. Many of them will report data to the central coordinating site at U-M, to allow the success of the project to be tracked and to allow hospitals to share information about what’s working for them.

The project’s importance will grow as more small and midsize hospitals around Michigan seek to provide emergency angioplasty. In 2003, the state government began to allow hospitals that don’t perform heart surgery to provide angioplasty, so long as they have an agreement in place with a heart-surgery hospital for emergencies. In 2005, the state required that any hospital where angioplasties are performed must be ready to perform them around the clock, seven days a week.

The symposium was organized by members of the U-M Cardiovascular Center, members of the Michigan Chapter ACC, and members of St. Joseph Mercy Health System. It is funded by a grant from BCBSM/BCN to U-M as part of the company’s Value Partnerships to improve the quality and efficiency of health care in the state. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit and independent licensees of the Blue Cross and Blue Shield Association.

For more information, contact:
U-M Health System: Kara Gavin, kegavin@umich.edu, 734-764-2220
ACC Michigan Chapter: Alice Betz, alice@accmi.org, 517-663-6622
Blue Cross Blue Shield of Mich.: Jon Ogar, jogar@bcbsm.com, 517-336-5648

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