Wisconsin Heart Attack Program Helps Beat the Clock

Sep. 10--Gary Cockerman had just finished water skiing on Rock Lake in Lake Mills when his arm began to hurt, he started sweating and he suddenly felt chest pain.

The 64-year-old was having a heart attack. But he was a long way from Madison, which has the only hospitals in the area that offer angioplasty. The procedure, in which a catheter opens clogged arteries, is considered better than clot-busting drugs if performed quickly.

A new "Level 1 Heart Attack Program" at hospitals in Madison and throughout the region helped Cockerman beat the clock.

An ambulance rushed him to Fort Memorial Hospital in Fort Atkinson, where doctors quickly determined he should be transferred to UW Hospital. They promptly called for Med Flight. By the time a helicopter flew him in, cardiologists in Madison were waiting.

"They wheeled me out, took me down an elevator, and the next thing I knew I was in the room getting the angioplasty," Cockerman said.

Time from his arrival in Fort Atkinson until his artery was cleared: 92 minutes.

That's very near the goal of 90 minutes (two hours is considered acceptable) and a far cry from the three hours or more it often takes patients in rural areas to get angioplasty, doctors say.

Reducing the interval is the aim of the heart attack program, developed three years ago at the Minneapolis Heart Institute and now being adopted elsewhere, including in Madison.

Precious minutes

About 1.2 million heart attacks strike Americans each year, according to the American Heart Association.

Through a series of changes -- giving some drugs orally instead of intravenously, calling Med Flight before certain tests are run, ensuring that a hospital room is available without filling out paperwork -- medical teams are shaving off precious minutes that can save lives.

Once a clogged artery blocks blood flow and causes a heart attack, every minute can kill more heart muscle, said Dr. John Phelan, chairman of the Dean & St. Mary's Cardiac Center at St. Mary's Hospital.

"The faster you can open that artery, the more muscle you salvage," Phelan said.

Under the new program, doctors treat heart attacks as they would car crashes and other traumas, for which a quick response is crucial, said Dr. Darren Bean, a UW Health physician who works on Med Flight.

"We sprint to the helicopter and get the information (about the patient) later," he said.

UW Hospital launched the program in March. St. Mary's started in July.

Meriter Hospital's Wisconsin Heart Institute has been following many of the steps for years, said Dr. Joseph Bellissimo, Meriter's director of cardiology. The hospital is now making the effort more formal, he said.

Some of the steps may seem like common sense, but they involve breaking down barriers within hospitals, Bellissimo said.

For example, cardiologists long didn't trust emergency room doctors to decide whether patients need angioplasty, he said. The cardiologists feared false alarms would force them to come to the hospital unnecessarily, sometimes in the middle of the night.

That has happened occasionally, Bellissimo said, but the doctors have learned to accept it.

"We've sort of pounded that out of the system," he said. "Every now and then (the cardiologists) might not be used, but that's the price you pay for treating every patient as quickly as possible."

Withholding drugs

Each of the Madison hospitals has been working on the program with the regional hospitals, within about 60 miles of the city, that often send heart attack patients here.

Those hospitals don't offer angioplasty, which is generally performed only at large referral centers.

Regional hospitals are able to give heart attack patients thrombolytics, drugs that can unclog arteries. Doctors say the drugs are effective, especially if angioplasty isn't available at all.

But studies have shown that if angioplasty is done within about 90 minutes, it is better.

Deciding to withhold the drugs and refer patients to Madison for angioplasty has been an adjustment, but a good move for patients, said Dr. Daniel Beaver, an emergency room physician at St. Clare Hospital in Baraboo.

"In the past, we felt an obligation to give thrombolytics right away," he said.

The drugs are sometimes still given if it's clear a patient won't come close to meeting the 90-minute goal -if bad weather has grounded Med Flight and the patient is far from Madison, for example.

If the drugs fail, angioplasty can still be performed. But the procedure is considered riskier on patients who have taken the drugs, said Bean of UW Health.

Another change at the regional hospitals: Doctors no longer wait until Med Flight arrives before preparing the patient for flight, Beaver said.

"As we hear the chopper blades coming, we pull everything off, all the tubing, all the electrical gadgets, so (the Med Flight crew) can be in and out of here in five minutes," Beaver said. "In the past, it may have taken 15 to 25 minutes."

En route, Med Flight crews now deliver heparin, a blood thinner, as a shot instead of intravenously, Bean said. And they give the chest pain medication nitroglycerin as a paste instead of an IV.

Minimizing the number of IVs allows the patient to be removed from the helicopter more quickly, he said.

Ambulances in Dane County recently have been equipped with 12-lead electrocardiogram machines, or EKGs. The devices can transmit heart rhythm data from the field, which also saves time.

Death rate lower

In Minneapolis, where more than 1,000 patients have been treated under the program, patients within 60 miles have received angioplasty in an average of 95 minutes, according to the Minneapolis Heart Institute.

The death rate for patients 30 days after a heart attack has dropped to 4.2 percent, compared to a national average of 7.2 percent.

Madison's hospitals hope for similar results. Staff want the public to help.

"If we could get the patient to call 911 the minute they have chest pain instead of thinking they have indigestion, that would really do it," said Marlene Pechan, vice president of the Dean & St. Mary's Cardiac Center.

Wally Cegielski complied.

The semi-retired insurance adjuster from Mosinee was golfing in the Wisconsin Dells last month when he suddenly developed chest pain, rapid sweating and shortness of breath.

"I knew right away what was happening," said Cegielski, 69, who had his first heart attack eight years ago.

He told his golfing friends, who took him to the clubhouse, where they called 911.

An ambulance brought him to St. Clare, where doctors decided to send him to St. Mary's. The weather was bad, so Med Flight couldn't fly. The ambulance ride to Madison took 74 minutes.

But Cegielski still received angioplasty within 129 minutes, much quicker than he would have before the program began, doctors said.

"I feel better than I thought I ever would," Cegielski said recently, as he was preparing to go fishing with his grandson.

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