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A Lifesaving Metric: Door-to-Balloon Time

 

When you’re having a heart attack, the only thing that matters to you is getting blood flowing to your heart.

Heart attacks occur when the flow of blood to the heart is blocked, usually by a build-up of plaque inside the coronary arteries around the heart. Deprived of oxygen, the body can experience a host of uncomfortable symptoms, from chest pain and shortness of breath to nausea, shoulder pain, jaw pain and other symptoms.

One of the best ways to treat the blockage is through angioplasty and stenting — also called a percutaneous coronary intervention, or PCI. With PCI, a cardiac specialist can thread a tiny catheter through your arteries, often entering through the major arteries in the groin or the wrist — to the site of the blockage, then inflate a tiny balloon at the end of the catheter. As the balloon expands, it presses against the walls of the artery and clears the blockage. (Often, a cardiologist will then place a tube of wire mesh, called a stent, in the artery to help prevent future blockages at that site.)

As an interventional cardiologist, there are few things more rewarding than seeing the relief on a patient’s face when that balloon expands and the blood rushes back into the heart. There’s the immediate cessation of symptoms, but also the awareness that he or she is going to get to walk out of the hospital and return to their loved ones.

One of the most important ways clinicians measure how well their heart care programs are doing is by a metric called “door-to-balloon time.” That is, the time from when a patient arrives at the hospital — from when he or she hits the door — to the second that an interventional cardiologist uses the balloon to clear the blockage and restore the flow of blood to the heart.

Door-to-balloon time matters because, deprived of oxygen, heart tissue begins to die. And it doesn’t “grow back” — once it’s gone, it’s gone. This can impact the heart’s ability to pump blood, leave the heart weak or even result in death. The faster the door-to-balloon time, the better the outcome for the patient and the better the prospect that the patient will be able to return to an active lifestyle.

There’s a lot that has to happen, however, between the hospital doors and the catheterization lab table where PCI is performed. The patient has to arrive, the heart attack has to be diagnosed (which itself often requires a round of tests that can include an EKG and bloodwork), the interventional team has to be assembled, the catheterization room has to be prepared and the location of the blockage (or blockages) has to be identified.

At Tanner, we’ve evaluated our processes over and over again, streamlining communications, improving efficiencies and drilling our staff to achieve the lowest door-to-balloon times possible.

Just having PCI available in Carrollton and Villa Rica saves hearts and lives almost every day — according to an article in Diagnostic and Interventional Cardiology, a patient who has to be transferred to a hospital with an interventional cardiology program can expect an average door-to-balloon time of more than 120 minutes, as opposed to just more than 60 minutes at hospitals that offer PCI on-site. And at Tanner, our door-to-balloon times are still often lower even than the national average and much lower than suggested guidelines of 90 minutes.

That’s no small feat — a lot has to happen right, and right away, to move through arrival to diagnosis and interventional treatment. But that work has paid dividends for our heart program, not only earning us accreditation as certified chest pain centers but empowering us to save our neighbors’ hearts and lives every day.

Citing the importance of door-to-balloon times in successful clinical outcomes, the American College of Cardiology (ACC) has tracked efforts to reduce times nationwide. In a five-year period, from 2005 to 2010, the ACC tracked 1,000 hospitals and found that the median door-to-balloon times dropped nearly 30 percent at those facilities, from more than 94 minutes to just more than an hour.

To stay in the top tier of hospitals, Tanner is continuing to push the envelope, sometimes achieving average door-to-balloon times of just more than 30 minutes — half what you might expect at other, larger hospitals. With supervision from impartial third-party programs like the Society of Cardiovascular Patient Care (SCPC), The Joint Commission, Healthgrades and others, we’re implementing best practices, refining our processes and doing everything possible to ensure that when you or someone you love arrive at our hospital, the help you need will be ready for you — fast.

Learn more about our nationally recognized interventional cardiac care at TannerHeartCare.org.

Dr. Khawaja is board-certified in cardiovascular disease and interventional cardiology by the American Board of Medicine and serves as chief of interventional cardiology for Tanner Health System and medical operations leader for Tanner’s heart and vascular services. He earned his medical degree from the University of South Alabama. After completing a residency in internal medicine at Albany Medical College in Albany, New York., Dr. Khawaja completed a fellowship in cardiovascular medicine at Dartmouth-Hitchcock Medical School and interventional cardiology subspecialty training at the University of Minnesota/Minneapolis Heart Institute. Dr. Khawaja also received advanced training in peripheral vascular interventions at the Arizona Heart Institute.

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