Among the highlights:
• The time between first medical contact to when a doctor uses angioplasty to open a blocked artery should be 90 minutes or less. This means that the cardiac team that will work on a patient should be alerted as soon as the patient is checked by an emergency medical service.
“It’s critical for the hospital to be ready as soon as that patient arrives,” said Dr. Mauro Moscucci, chief of the cardiovascular division at the University of Miami Miller School of Medicine. “You need to activate a very complex system and the best way to do this is contact the hospital on the way there.”
In Franklin’s case, the team was already at the cat lab.
• To speed diagnosis, emergency medical technicians should perform electrocardiograms in the field. Johnson of South Miami Hospital says many EKGs are done in the patient’s house or on the emergency truck. “We can then start preparing for the patient before the patient even arrives,” she said.
• Therapeutic hypothermia — lowering the body temperature to protect the brain from damage — is recommended if a patient goes into cardiac arrest.
Years ago, UM’s Moscucci added, there was no standard practice in treating heart attack patients. That has evolved steadily so that there has been a 50 percent reduction in heart attack deaths in the past five decades.
This is important because STEMIs affect about 25 to 40 percent of the 683,000 people who are diagnosed with obstructed coronary arteries every year.
Moscucci said evolution of treatment includes the introduction of the ICU, or Intensive Care Unit, concept and the use of aspirin therapy and clot-busting medications. In the past two decades angioplasty, the mechanical opening of a blocked artery, has also contributed to improved heart attack survival.
“There has been tremendous progress,” Moscucci said. “It’s one of the real successes in modern medicine.”
In addition to the national guidelines, local hospitals have their own time goals to treat patients. For example, in Franklin’s case the complex procedure to revive him took only 35 minutes. “We had to work like clockwork,” Beohar said, adding that Mount Sinai Heart Institute has the best heart attack survival rate in Florida.
Hospitals also measure the efficacy of their heart attack treatment by how quickly a patient makes it from hospital door to angioplasty, when the artery is opened, ideally within 60 minutes.
Cardiologists, however, point out that guidelines are useless if the patient doesn’t dial 911 as soon as they recognize the onset of heart trouble.
“A very important component is patient education, knowing the common symptoms but also the symptoms that aren’t typical,” Moscucci said.
Johnson said she urges people not to second guess themselves. Too many attribute heart attack symptoms to indigestion or muscle spasms.
“It’s OK to be wrong,” she said. “The only downside of being wrong is really not so bad.”