Quicker treatment is only part of the story
The Daily Briefing’s Dan Diamond spoke with Brian Contos, who oversees the Advisory Board’s clinical research and insights programs, about the connection between faster care for acute myocardial infarction and the falling death rate for cardiovascular disease.
Question: In a front-page story on Sunday, the New York Times suggests that we can attribute the 38% decline in heart disease death in part to providers’ faster treatment for heart attack patients.
Brian Contos: When I think of the significant drop in the cardiac death rate, I think of broad prevention efforts and quicker treatment for those that have heart attacks (and perhaps in that order).
Not to say fast action isn’t important, but the incremental gains of the last few years when it comes to door-to-balloon time are just that—incremental.
Q: So what is the connection between faster heart attack care and fewer deaths? The research hasn’t found a strong link, right?
Contos: Indeed, a NEJM study in 2013 showed that despite gains in [door-to-balloon] time, there was no overall reduction in mortality. Small additional gains on DTB time are likely less important to improving outcomes compared to reducing pre-hospital delays, which is important for reducing the “total ischemic time.”
And there are other metrics that we need to work on that will impact overall outcome of STEMI patients, like 30-day mortality.
Q: You’ve been researching cardiovascular best practices for more than a decade. What’s your takeaway?
Contos: Here’s what this tells me: We have to look at the full continuum of care and all the opportunities to inflect outcome.
It’s one reason why we’ve developed our blueprint for heart failure centers, as well as our blueprint for cardiovascular care management. Providers’ opportunities to save lives start long before a patient has a heart attack, and continue for those who do have an acute event, in the days, weeks, months and years afterward.