The PulseThe Pulse

A quarterly publication of Cardiovascular Services at Advocate BroMenn Medical Center

In this issue:• Earlytreatmentforaheartattack

• RadialArteryApproachtoCardiacCatheterization

• Keypracticeguidelinemeasures

• AsktheExpert–Q&A

• UpcomingCMEOpportunities

Winter 2012-13

early Treatment for a heart attack can prevent or limit damage to the heart muscleAdvocateBroMennMedicalCenterisoneofthefirst hospitals in IllinoistoreceivetheAmericanHeartAssociation’sMission:Lifeline®HeartAttackReceivingCenterAccreditation.ThisrecognizescentersthatmeetorexceedqualityofcareSTEMImeasures.

“Thisexceptionalcarecanonlybeachievedwithstrongteamworkandprocesses—witheveryonefrom911dispatchersandfirstresponders,toourphysiciansandED,CathLab,CVCUandotherstaffworkingeffectivelytogether,”saysJamesMcCriskin,DO,cardiologistwithAdvocateMedicalGroup–IllinoisHeartandLung.

QuickrecognitionofaSTEMIandopeningtheculpritarteryiskeytosavingheartmuscle.Asatopperformerinthenation,BroMenn’saverage“door-to-balloon”timeforthepast12monthsis46 minutes.Nationalstandardscallforopeningtheculpritarterywith90minutes.CallingtheCodeSTEMIfromthefieldforearlyactivationoftheCathLabteamiskeytoachievethis.

TheaccreditationalsoincludesrelationshipswithourSTEMIReferralCenters(outlyingruralhospitals,suchasAdvocateEureka,GibsonCityAreaHospital,andDr.JohnWarnerHospital).BroMenncollaborateswiththesehospitalstoprovideinformationonpracticeguidelinesandSTEMIcasereviews.Theuseofourhospital’sPriorityLinehelpsexpeditethe“ExpressSTEMI”process.

Tolearnmore,visitadvocatehealth.com/bromenn/heart.

Call 9-1-1 if you or a loved one experiences any of the following warning signs of a heart attack:

•Chest discomfort,likeuncomfortablepressure,squeezing,fullnessorpain

•Discomfort in other areas of the upper body,includingpainordiscomfortinoneorbotharms,theback,neck,jaworstomach

• Shortness of breathwithorwithoutchestdiscomfort

• Other signs,suchasbreakingoutinacoldsweat,nauseaorlightheadedness.

Radial Artery Approach to Cardiac CatheterizationDarren Sawyer RN, Charge Nurse Cath Lab

IntheUnitedStates,themostcommonapproachforcardiaccatheterizationisthroughthefemoralarteryinthegroin.Whilefemoralarteryproceduresaresafe,datashowsthatbleedingcomplicationsfromfemoralarterypuncturemaybemoresignificantthanpreviouslybelieved.

Toreducethepotentialforcomplications,cardiologistsarenowbeginningtoutilizetheradialarteryineithertherightorleftarm.RobertBraastad,MDandSiddharthGandhim,MDofAdvocateMedicalGroup–IllinoisHeartandLung,havebeenusingtheradialapproachfornearlytwoyearswithgreatsuccess.Whiletheaverageutilizationratefortheradialarteryapproachnationwideis15percent,theutilizationrateatAdvocateBroMennis34.5percent.

AccordingtotheMortalitybenefitOfReducedTransfusionafterpercutaneouscoronaryinterventionviatheArmorLeg(MORTAL)study,patientsundergoingradialarteryaccessforcardiaccatheterizationrequiredhalfthenumberofbloodtransfusionsasthosehavingproceduresusingthefemoralartery.Inaddition,theMORTALstudyconcludedthatpatientsundergoingcardiaccatheterizationthroughtheradialarteryexperiencedasignificantreductionin30dayandoneyearmortality.

Patientsalsobenefitinotherwaysfromradialarteryapproach.Withnofemoralarterypuncturesitethereisnobedrestrequiredforpatientswhohavehadradialapproach.Patientsareallowedtousetherestroom(insteadofusingthebedpanasforfemoralarteryaccess)andaremorecomfortableeatingwhilesittingupeitherinachairorontheircart.

Key Practice Guideline MeasuresTheAdvocateBroMennteamdoesagreatjobwiththekeypracticeguidelinemeasuresshownbelow.Oneinitiativesistoreduceheartfailurereadmissions,anationwideconcerninthehealthcareindustryastheagedpopulationincreases.BroMenn’srateis19.4percent(unadjusted).Effortsarebeingmadetotrendthisdownward.Pleasestayintuneforfutureupdates.

Cardiac Care October 2011 – September 2012

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20%

40%

60%

80%

100%

AMI Perfect Care

Heart Failure Perfect Care

ICD Implants meeting

Guideline Indications

Open Heart Patients

Discharged Alive

98%100% 100% 100%

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AdvocateBroMennMedicalCenter||1304FranklinAvenue,Normal,IL61761||advocatehealth.com/bromenn

upcoming CMe Opportunities

January15,2013at0700inHeartCenterConferenceRoom—EchoConference

January22,2013at0700inHeartCenterConferenceRoom—HeartFailureStandardsofCare:APracticalUpdate

Ask the expert—Q & ADoyouhavequestionsorfuturetopicsthatyouwouldlikemoreinformationonrelatedtothecardiovascularservicesatAdvocateBroMennMedicalCenter?TheCVteamwouldliketoprovideinformationthatishelpfultoyou.Pleasesubmitanyquestionsortopicrequestsforfuturepublicationstooneofthefollowinglistedbelowbyemail,oryoucancallLyndaRhinehart,at309.268.5318.

JamesMcCriskin,DO,FACCMedicalDirector,CVServiceLinejim.mccriskin@advocatehealth.com LyndaRhinehart,RNDirectorCardiopulmonaryServiceslynda.rhinehart@advocatehealth.com