Paramedics have begun bypassing community hospitals in Arlington and Monroe to get heart attack victims to more distant medical centers in Everett and Edmonds that perform angioplasty, or the ability to quickly open blocked blood vessels.
Angioplasty "improves outcomes and saves lives," said Dr. Cindy Markus, a doctor at Providence Everett Medical Center’s emergency room.
In Snohomish County, heart attack patients generally are taken directly to Providence or to Stevens Hospital in Edmonds.
"We may not transport to Valley General Hospital (in Monroe) even though it’s the closest hospital" if a patient is having a heart attack, said Merlin Halverson, chief of Fire District 5, which serves 71 square miles between Gold Bar and Monroe.
"I think the paramedics know, when an angioplasty is required, in our case, we’ll head west," he said.
Evidence has been building since the late 1980s that angioplasty works better than the clot-busting drugs offered at smaller hospitals. In all, 23 studies have compared the drugs to angioplasty, which uses a surgically implanted balloon to open a blocked blood vessel.
Not only is the risk of death lower with angioplasty, but the risk of recurring heart attack drops in half.
Smaller hospitals often can’t afford to offer angioplasty.
Clark Jones, co-administrator of Cascade Valley Hospital in Arlington, said if an ambulance goes out and a heart attack is suspected, "they immediately do an EKG," a test showing the heart’s electrical activity caused by contraction of the arteries.
"If it looks like you’ve had a heart attack, you’ll bypass this hospital and go right to Providence," he said.
By year’s end, a formal agreement is expected among all the county’s fire districts, with paramedics ensuring that heart attack patients are transported to a hospital with angioplasty, said Dr. George Cozzetto, medical program director for Snohomish County Emergency Medical Services.
"It’s the current state-of-the-art approach to management of patients with acute heart attacks," he said.
Last year, Providence performed angioplasty on 842 patients. About 75 a year are performed at Stevens.
At both hospitals, doctors can usually begin the life-saving procedure about 90 minutes after the patient arrives.
Nearly half of all patients brought to Providence with heart attack symptoms receive angioplasty, either immediately or before they are discharged, said Tom Brennan, who oversees the Everett hospital’s heart program.
The state average is 19 percent, he said, and nationally about 26 percent of patients receive the procedure.
Among the reasons angioplasty is preferred over clot-busting drugs is that drug therapy takes 90 minutes to two hours to work, "and it doesn’t work all the time," Brennan said.
By using a machine that gives physicians virtually live, moving X-rays of the heart and its vessels, "you can clearly see by the blood flow" the result of the angioplasty, he said.
Nationally, with only about a third of heart attacks treated with angioplasty, most patients end up at hospitals that cannot perform them and are never transferred to hospitals that can.
Markus led a committee that is recommending a statewide system to ensure that heart attack patients all have access to angioplasty.
"As far as we know, no other state has embarked on a statewide system," she said.
However, it could take up to five years to accomplish that goal. It requires approval from the legislature and time to write the rules of how it will work. It also requires money to keep records.
The system would be modeled on the statewide trauma system, which allows paramedics to bypass a hospital with a lower-level designation to get to one that can treat seriously injured patients if the patient can be delivered to that hospital within 30 minutes, Markus said.
Meanwhile, too many Snohomish County patients with heart attack symptoms are waiting to seek medical attention longer than they should, Brennan said.
Only 36 percent of local patients are treated within two hours of when symptoms begin, he said. Nationally, 49 percent of patients are treated within two hours.
"We’re 13 percentage points below the national average," Brennan said. "They’re just slower. I don’t know if it’s the Scandinavian blood, rural, tough people, or what that makes them just put up with the pain longer."
The average age for a heart attack in Snohomish County is 64 for men and 71 for women, he said.
Seeking quick medical treatment is critical. The longer blood flow is cut off from part of the heart, the more heart muscle dies. The more damage, the greater the chance of needing pacemakers or life-long drug therapies.
"Ninety percent of people survive a heart attack," Brennan said. "The question will be: In what shape?"
The Associated Press contributed to this report.
Reporter Sharon Salyer:
425-339-3486 or salyer@heraldnet.com.
Some heart attacks are sudden and intense, and there’s no doubt about what’s happening. But most heart attacks start slowly, with mild pain or discomfort. Often, victims aren’t sure what’s wrong and wait too long before seeking help.
Here are signs that can mean a heart attack is happening:
Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath. This feeling often comes along with chest discomfort. But it can occur before the chest discomfort.
Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness.
Source: American Heart Association
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