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GREENSBORO — Efforts to speed care for heart attack patients at Moses Cone Hospital predated those in a statewide initiative whose results were announced Sunday by the American Heart Association.

In that initiative, researchers compared treatment times before and after systemic changes in the way 10 N.C. hospitals, including Cone, that perform balloon angioplasties handled heart attack patients.

The report on the initiative found dramatic improvement in how quickly patients began receiving the angioplasties, the preferred treatment for most heart attacks. In that procedure, a small inflated balloon is used to open clogged heart arteries.

Cone had begun in 2004 to try to reduce the time between when a possible heart attack victim arrived and when that person received a balloon angioplasty. That’s because heart muscle begins to die from the moment an artery to the heart is blocked during a heart attack. The sooner the artery can be reopened, the better the patient’s likely outcome.

In 2004, the so-called "door-to-balloon" time averaged about three hours per patient, Dr. Charles Wilson said Monday. Wilson is the medical director of Cone’s heart and vascular center.

"Even before the (statewide initiative), we’d recognized that our time was longer than desirable and had begun efforts to shorten it," Wilson said.

Those efforts involved looking at every step of the process through which patients were treated, looking for ways to cut steps and time. The efforts were modeled after the hospital’s efforts to cut treatment time for trauma patients.

As a result of the review, entering patients complaining of chest pain now receive an electrocardiogram, an electronic analysis of heartbeat patterns, within five to 10 minutes of arrival. Before, patients might have had to wait up to an hour, Wilson said.

The results of that EKG are now given immediately to the emergency department physician, Wilson said. That doctor has the authority to page a variety of personnel with a single call to Care Link, which serves as Cone health system’s dispatcher. It pages:

* The catheterization lab, where angioplasty is performed, and the three people who are on call to staff it.

* Bed control to find a bed for the patient.

* The cardiologist on call to perform the procedure.

* The pharmacy, to prepare the drugs typically given to heart attack patients.

* A team of nurses skilled in critical care.

Before, patients en route to the catheterization unit would be given heparin and nitroglycerin intravenously to prevent clotting and expand blood vessels, Wilson said. But to save time, the patient now gets a single shot of heparin and a nitroglycerine skin patch.

The hospital also made a procedural change. Instead of requiring all three catheterization-lab staff members to be present before calling the patient up from the emergency department, the hospital allows a single staff member to call as long as the other two are en route, Wilson said.

The cardiologist then examines the patient. In 10 to 20 percent of cases, he will decide the patient needs additional examination, is not having a heart attack or is not an appropriate candidate for angioplasty.

"But we feel a 10 to 20 percent false positive rate is acceptable in order to shorten the time for the remaining 80 to 90 percent" of patients, Wilson said.

The hospital also worked with Guilford County Emergency Medical Services to train paramedics to read EKG results in the field.

Wilson said he hopes the next step will be transmitting EKG results wirelessly from ambulances to hand-held devices in the hands of emergency-room physicians and cardiologists.

The result? In 2004, when Cone’s efforts began, door-to-balloon times were averaging about 180 minutes. By the time the state initiative sampled three months’ worth of Cone data from July through September 2005, that number had been reduced to 98 minutes. Data collected in the first three months of this year showed a further decline, to about 90 minutes.

"That was the goal, but we wanted it to be better than that," Wilson said, and the times now average about 60 minutes.

The efforts also benefit patients in outlying counties such as Randolph and Rockingham, where hospitals do not have catheterization labs. Paramedics there can read EKGs and decide to take patients to Moses Cone or High Point Regional Health System’s heart units without stopping first at the local hospital for examination. That change, Wilson said, can save 30 to 60 minutes.

High Point Regional Health System, although not an official participant in the statewide initiative, has been taking part in its meetings, said Dr. Steven Rohrbeck of the health system’s Carolina Regional Heart Center.

That center’s door-to-balloon time for the past three months has been an average of 53 minutes, he said.

Because the hospital had not been part of a formal data-gathering effort, he had no data for comparison, but he said: "I think we’ve probably made some real improvement in the past year."

Contact Lex Alexander at 373-7088 or lalexander@news-record.com