Quebec hospitals slow to treat heart attacks: study

A majority of Quebec's heart-attack victims may not be getting proper treatment within medically recommended times, according to a new study published in the Canadian Medical Association Journal.

The study reviewed the medical charts of 1,189 heart-attack patients admitted to 17 different Quebec hospitals in 2003.

More than half of the patients did not receive an intravenous clot-dissolving treatment within 30 minutes of their admission to hospital, despite the fact the procedure is recommended for acute myocardial infarctions.

About a third of patients also failed to receive a balloon angioplasty within the first 90 minutes of admission, even though it is the preferred alternative treatment to an IV. The procedure involves inserting a tiny balloon into the blocked coronary vessel, and pumping it up to squeeze out the clot.

The recommended times for both treatments are guidelines and not laws, but they exist for a reason, said study co-author Dr. Erick Schampaert, a cardiologist at Montreal's Sacr Coeur Hospital.

"It's a continuum. It doesn't mean because you give [the treatment] at 32 minutes that it's not going to work, or that the patient is going to die. But the faster you administer either of these therapies, the better it is for the patient," he told CBC.

Waiting for initial treatment can lead to complications and, potentially, death, because every minute counts when someone is having a heart attack, he added. "If you open the artery quickly, a good portion of the muscle will suffer without dying, and that will limit the scar size. As the scar gets bigger and bigger, it gradually menaces the patient's life."

The study's authors blame the delays on poor organization in emergency rooms, staff shortages, and transferring patients between hospitals because of overflow.

The study has forced the Sacr Coeur Hospital to reorganize its ER, in order to reduce wait times for initial treatment, Schampaert said.

He expects other Quebec hospitals to follow suit. "I have the strong impression that not just in our institution, but that overall in all of Quebec, things have improved because of the awareness."

The study recommends the following:

• Craft aprotocol for treating heart attacks that all Quebec hospitals can adopt.
• Improve how patients are transferred between hospitals.
• Create a provincial registry to track heart-attack treatment delays.

The study was conducted by 10 Quebec-based physicians.