Cleveland Clinic-Developed Protocol Improves Heart Attack Patient Survival
On Nov. 15, a new study from the Journal of the American Heart Association has shown that a Cleveland Clinic-developed protocol improved the chances of in-hospital survival among patients who experience the most severe type of heart attack (STEMI), and reduced door-to-balloon time for all patients, regardless of socioeconomic factors.
A press release from the Cleveland Clinic states that “The protocol, designed to reduce variability in care, may be used as a tool to reduce healthcare disparities during life-threatening, time-sensitive conditions such as STEMI (ST-Segment Elevation Myocardial Infarction). The study’s population included over 1,700 patients across Northeast Ohio, 71 percent of which were from low-socioeconomic communities.”
That said, “Heart disease is the leading cause of death in the United States and worldwide, and STEMI, a life-threatening type of heart attack that is caused by a sudden and prolonged blockage of the blood supply to the heart, is a primary cause of death in patients with heart disease.”
Further, “Nationally, residents of disadvantaged neighborhoods or communities are at increased risk for mental illness, chronic disease, higher mortality, and lower life expectancy. Some population groups living in poverty are more likely to have adverse health outcomes than others. For example, the risk for chronic conditions such as heart disease, diabetes, and obesity is higher among those with the lowest income and education levels.”
The release explains that studies have shown that care and outcomes of STEMI patients vary based on an individual’s socioeconomic status, even after considering differences in cardiovascular risk factors. So, in 2014, Cleveland Clinic put in place a standardized four-step protocol for STEMI patients designed to minimize variability in care.
“The protocol included: (1) standardized emergency department cardiac catheterization lab activation criteria, (2) a safe handoff checklist, (3) immediate transfer to a cardiac catheterization lab, and (4) using the radial artery in the wrist as the first option for access to the heart’s arteries,” the release states. “This approach has been shown to have fewer bleeding complications and improved survival when compared to using the femoral artery.”
Additionally, the release added that “The study compared outcomes of 1,761 patients from different socioeconomic neighborhoods across Northeast Ohio, before and after the protocol was implemented. One of the major goals of the protocol was to shorten the time it takes to re-open a patient’s blocked heart artery from the time they enter the hospital (door-to-balloon time), and this improved significantly for all patients. In addition, the rate of in-hospital death among patients residing in low socioeconomic neighborhoods decreased by over 50 percent after the implementation of the protocol.”
Umesh Khot, M.D., head of Regional Cardiovascular Medicine at Cleveland Clinic, and senior author of the study was quoted in the release saying that “When we first started out on this journey over five years ago, we knew that this was an issue both nationally and locally, and we wanted to see if as a healthcare system we could improve the care of our most vulnerable patients at their most vulnerable time, such as during a heart attack. We sought to transform the care of these patients by eliminating care variability so that all patients received the highest level of standardized care every time.”
