New Guidelines Seek to Streamline Care for Worst Heart Attacks

Time is of the essence to avoid brain damage and save lives, experts say.

MONDAY, Dec. 17 (HealthDay News) -- Streamlined guidelines meant to improve treatment of patients with the most severe form of heart attack were released Monday by the American Heart Association and the American College of Cardiology.

The updated recommendations are for a type of heart attack called ST-elevation myocardial infarction (STEMI). It occurs when a cholesterol plaque ruptures and a blood clot forms within an artery leading to the heart muscle, completely blocking the blood flow. This can lead to damage to a large area of the heart.

This type of heart attack strikes about 250,000 Americans a year.

"Time is of the essence in the evaluation and treatment of these patients," Dr. Patrick O'Gara, chairman of the guidelines-writing committee, said in an American Heart Association news release. "The sooner blood flow is restored, the better the chances for survival with intact heart function."

Percutaneous coronary intervention is the preferred treatment when it can be done quickly. The treatment includes balloon angioplasty to open a clogged artery, followed by the insertion of stents to keep the artery open.

Patients who are taken to a hospital where percutaneous coronary intervention is not available should be given clot-busting drugs, if safe, followed by transfer to a facility where the angioplasty-stent treatment can be performed if needed, according to the guidelines published online Dec. 17 in the journal Circulation and the Journal of the American College of Cardiology.

The guidelines noted that patient delay in reporting symptoms is a major obstacle to timely and successful care of STEMI, and called for efforts to improve patient recognition of heart attack symptoms and to make people understand the importance of immediately calling 911 rather than traveling to the hospital by car, for example.

Among the other recommendations:

• Emergency medical technicians should perform electrocardiograms at the scene to speed patient assessment and treatment.
• To reduce brain injury, cooling procedures should be started before or at the same time as cardiac catheterization.
• Patients should be provided with care plans when they're discharged from the hospital. The plans need to be clearly communicated and shared with patients, families and other health care providers. Referral for cardiac rehabilitation is a key part of a care plan.

More information

The U.S. National Heart, Lung, and Blood Institute has more about heart attack.