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NC accelerates heart attack care

Duke University’s success in improving heart attack treatment in North Carolina will be emulated in other parts of the country.

In 2005, Duke medical researchers designed the RACE-ER program to coordinate and accelerate heart attack treatment in hospitals across North Carolina. Since its expansion in 2008, RACE-ER has helped health care facilities reduce the time between first contact with a patient and treatment by 12 minutes—an approximate 10 percent reduction in time, Dr. Christopher Granger, Duke cardiologist and RACE-ER founding member, wrote in an email June 20.

The researchers who launched the program recently published a study documenting its effectiveness. “We are fortunate in North Carolina to be setting the example for other people across the nation on not only how to improve heart attack care, but also cardiac arrest care as well,” said Lisa Monk, co-author of the study and project leader at the Duke Clinical Research Institute.

After witnessing the success of the program, The American Heart Association has used RACE-ER as a model for their national program, Mission Lifeline, which focuses on the prompt treatment of acute heart attack care, Monk said.

RACE-ER focuses on improving the speed and efficiency of treatment for heart attack patients. This includes equipping and training paramedics to diagnose heart attacks, creating a plan to communicate the results to the right hospitals, taking patients to the most appropriate hospitals and assuring teams are ready for patient arrival, Granger said.

Increased paramedic training devoted to reading an EKG—a device that measures the electrical activity of the heart—has greatly improved heart attack care, Monk noted.

“It’s so important [to train paramedics] because if they can read an EKG and see it’s a heart attack, they can pre-notify the hospital that they are coming in with that heart attack patient... so that the team is ready to go,” she said.

The North Carolina program involves 119 hospitals—21 of which are large percutaneous coronary intervention centers—and more than 540 EMS agencies, Monk said.

PCI, formerly known as angioplasty, is currently the best available treatment for heart attacks, Granger said. It involves inflating a balloon in the artery to push back blockages.

Reducing the time it takes for a patient to get to a PCI center improves the amount of heart muscle saved during surgery and mortality rates, Granger said. As a result of RACE-ER, mortality has dropped from about 6.9 to 5.7 percent.

STEMI Heart Attacks

Although RACE-ER strives to treat all heart attacks, it has focused largely on STEMI heart attacks—the deadliest form of heart attack that results from total blockage of a major artery, Dr. Robert Califf, vice chancellor for clinical and translational research, wrote in an email June 21.

Physicians rely on PCI to treat patients with STEMI heart attacks. By diagnosing patients who need STEMI surgery in the field, medical workers can transport patients to those medical centers that provide this more advanced surgery.

“The heart muscle dies rapidly and every minute sooner the artery is opened reduces the amount of dead heart muscle,” he said. “Less dead heart muscle equates to better pumping function of the heart and lower risk of a sudden arrhythmia that can cause sudden death—in short longer life and less heart failure.”

STEMI affects about 300,000 people each year, according to the American Heart Association. Califf, who also serves as director of the Duke Translational Medicine Institute, noted that Duke and the RACE-ER program have had a major role in extending the lives of patients who experience STEMI heart attacks.

“One of the greatest thrills of my life is that when I started as a cardiologist we had no way to treat this problem and now we have slick devices and drugs that save lives,” Califf said. “It used to be routine to watch people die with no recourse. Now... four out of 10 people who would have died in the first year of my career walk out alive!”

A hotbed for heart attacks

The southeastern United States, including North Carolina, is a high-risk area for stroke, diabetes and cardiovascular death, Califf said.

“Without a doubt the high fat, high carb, high calorie [and] high salt diet—in short Bojangles and sweet tea—plays a key role,” Califf said.

Despite RACE-ER’s current success in improving cardiac arrest care, more can be done to improve time between diagnosis and treatment. As health professionals deliver more treatment in the field, survival will still come down to patients and their families dialing 911 in a timely manner, Califf said.

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