Quicker ‘Clot-Busters’ Use Urged in Heart Attack Cases : Health: Employing the drugs within 30 minutes of patients’ arrival at hospital will help to save lives, federal officials say.

Heart attack patients should be treated with so-called “clot-busting” drugs within 30 minutes after they arrive at emergency rooms, federal health officials recommended Monday in new guidelines designed to reduce death by heart attack, the leading killer of Americans.

Therapy using clot-busting--or thrombolytic--drugs works by dissolving blockages in the arteries and restoring coronary artery flow. Among the most popular are the expensive t-PA and streptokinase, a less costly alternative. A debate continues over which is most effective; the guidelines issued Monday endorsed no drug by name.

While not every patient is a candidate for the drugs, “too few patients are being treated (with them),” said Dr. Costas Lambrew, head of the cardiology division at Maine Medical Center in Portland and co-chairman of the National Heart Attack Alert Program, which issued the guidelines in a report.

Furthermore, many heart attack patients who are treated with the drugs often do not receive them early enough to achieve the most benefit, the report said.

Speeding up delivery of thrombolytic drugs was one recommendation in a report released by the Heart Attack Alert Program, a coalition of 39 national, scientific, professional, governmental and voluntary organizations. The program is administered by the National Heart, Lung and Blood Institute, part of the federal government’s National Institutes of Health.

The report was published in the February issue of the journal Annals of Emergency Medicine and represents the most comprehensive analysis to date of the major sources of delay in treating heart attack patients in hospital emergency rooms, the institute said.

Of the estimated 1.25 million individuals who suffer heart attacks annually, nearly 500,000 will die. Of these deaths, more than half will occur outside a hospital, within an hour of the onset of symptoms.

But even those victims who arrive at emergency rooms too often do not receive treatment quickly enough, the report said.

In the case of thrombolytic therapy, for example, the drugs often are not administered for an average of 60 to 90 minutes after a patient arrives.

Ideally, the report said, the treatment should begin for every eligible heart attack patient within one hour after the first symptoms occur--or within 30 minutes after arriving at an emergency room.

With treatment time crucial to a patient’s survival, “we challenge emergency departments across the country to identify barriers to prompt treatment of heart attack patients and to take steps to reduce those barriers,” said Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute.

The report identified numerous barriers to early treatment, including the patient’s own reluctance to seek help and glitches in emergency room operations.

Dr. Mark Smith, chairman of the group and head of the department of emergency medicine at George Washington University Medical Center here, said emergency departments need to reduce the time between arrival and treatment.

“But shortening only that time interval won’t be enough,” he said. “We have to reduce all of the delays from the very first symptom to the time of definitive treatment.”

Once a patient arrives at an emergency room, he or she must undergo a series of steps before drug treatment begins. It is during this process that delays often result, the report said.

Among the causes are outdated emergency department procedures for identifying heart attack patients; a long lag-time between patient registration and triage--evaluation of symptoms and setting of treatment priorities; slow access to an electrocardiogram machine; poor coordination between the emergency department and other hospital departments, such as the pharmacy, and turf disputes among medical staff.

The report recommended that procedures be established to evaluate patients rapidly based on an explicit list of “chief complaints” that would require immediate assessment.

Furthermore, the group said that electrocardiograms should be administered within five minutes after they are ordered.

Hospital staff responsible for treating heart attack patients should develop guidelines for initiating thrombolytic therapy, the group said. Moreover, emergency physicians “should have delegated authority to order such therapy without having to obtain prior consultation,” the report said.

Finally, the report recommended that thrombolytic drugs be stored in the emergency department to avoid delays that occur when drugs must be transported from the pharmacy.

The drugs are generally considered safe and studies have shown them to be very effective in reducing deaths from heart attacks.

Not everyone can take them, however. They are not recommended for pregnant women, individuals with active internal bleeding, uncontrolled high blood pressure, a history of stroke and several other conditions.