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For heart-attack patients, time is muscle.

And thanks in part to help from Guilford County Emergency Medical Services, Moses Cone Hospital is muscling its way well beyond the recommended standards for fast treatment for those patients.

The result? Far fewer deaths and debilitating heart injuries among patients.

In November, the federal government's National Heart, Lung and Blood Institute and the American Heart Association recommended that heart-attack patients receive an angioplasty - a balloon inflated within a blocked heart artery to reopen it - within 90 minutes of arriving at an emergency room.

That's because the faster a blocked artery can be reopened, the less likely the patient is to die or suffer debilitating heart-muscle damage.

When the recommendations came out, Cone had been working since 2004 to reduce its door-to-balloon time. In 2004, that time was about three hours. By early 2007, months ahead of the recommended standard, the average time had been reduced to about 90 minutes.

When the 90-minute standard came out, Cone's door-to-balloon time already was averaging just 60 minutes.

And in April, the most recent month for which statistics are available, Cone's door-to-balloon time averaged just 40 minutes.

The reduction in door-to-balloon time has slashed Cone's death rate for heart-attack patients, says Dr. Charles Wilson, medical director of the heart and vascular center for Moses Cone Health System.

Earlier this year, Cone's mortality rate for heart-attack patients was 9.9 percent. Now, Wilson says, it's down to 3.3 percent.

Even in patients who survive, delay in receiving an angioplasty is correlated with increased heart-muscle damage.

Such a patient, Wilson says, becomes more prone to congestive heart failure and can become "sort of a cardiac cripple."

The hospital is showing improvement in this area as well, Wilson says.

"In addition to reducing mortality ... we during that same period had no instances of congestive heart failure or patients in cardiogenic shock, and normally it ran 10 to 20 percent," Wilson says.

The road to reduction in door-to-balloon time starts well before patients hit the emergency-department door, says Dwayne Young, the county's emergency services manager for planning and research.

For years, Guilford County ambulances have been equipped with electrocardiograms, which examine electrical activity in the heart. Abnormal electrical patterns can indicate that a patient has had a heart attack.

Paramedics have been trained to read these results so they can determine on the spot whether a patient is likely having a heart attack. Since August 2007, trained paramedics who believe a patient is having a heart attack have been authorized to notify Care Link, a critical-care unit of Moses Cone that also serves as a call intake center.

Care Link then pages hospital personnel in addition to the emergency department. They include the cardiologist on call, critical-care nurses, the catheterization lab, the pharmacy and bed control, all of whom are now waiting and ready, or nearly so, when the patient arrives. Before, most of these personnel wouldn't have been notified until the patient arrived.

"Decisions are being made ... in the field rather than having to go through the emergency department to have all that repeated," Young says.

The advance notice lets the catheterization lab, where angioplasties are performed, gear up before the patient arrives, says Sheryl Booth, Cone's director for invasive cardiovascular services. Moreover, the times by which cath lab staff must arrive in the lab have been reduced.

And the emergency department is no longer required to start intravenous feeds for the patient before moving him to the cath lab.

These steps mean patients can practically bypass the emergency department and head straight to the cath lab.

The changes, and their results, have convinced both EMS workers and hospital staff of the need for what they are doing.

"That time saves lives," Booth says. "Our staff has had some incredible saves that probably would not have occurred had the patient not made it into the hospital and into the system as quickly as they have."

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