November 25, 2008 — The University of Virginia Health System is among the top 3 percent of U.S. hospitals in achieving one of the most important clinical performance metrics recommended by the American College of Cardiology and American Heart Association.

The metric tracks how well hospitals perform in providing primary percutaneous coronary intervention — a procedure that opens up blocked arteries with a balloon — within 90 minutes to patients suffering an acute type of heart attack known as ST-segment elevation myocardial infarction. The metric is one of six spotlighted in the latest update of the organizations' clinical performance measures, published online Nov. 10 in the Journal of the American College of Cardiology and in Circulation.
 
According to Dr. Michael Ragosta, an interventional cardiologist, 95 percent of the heart-attack patients arriving at U.Va. during the most recent fiscal year received the balloon treatment within 90 minutes of their arrival, an achievement that places the medical center in the 97th percentile of all U.S. hospitals.
 
"Many people may have heard this metric referred to as door-to-balloon time," Ragosta said. "We consider this to be one of the most important of all the AHA/ACC performance measures for two reasons. It reflects the quality of an institution's entire system for managing heart attacks. Also, treating a heart attack within this timeframe makes a huge difference in our ability to save lives and preserve heart muscle."
 
The updated clinical performance measures also cover drug therapy, referrals to cardiac rehabilitation programs, evaluation of a patient's left ventricular systolic function during hospitalization and several other metrics specifically for doctors and hospitals. According to Ragosta, U.Va. is performing very well on all current performance measures and will quickly embrace the revisions announced this month.
 
In a notable change, the metrics will now track treatment times for heart attack patients who are transferred from a hospital that does not perform the balloon procedure to one that does. Previously, there was no requirement to record door-to-balloon times for transferees due to difficulty in determining when patients arrived at the first hospital and when they received treatment at the second. Going forward, hospitals will be required to report door-to-balloon times for transferees.
 
This change will impact performance tracking at U.Va., Ragosta said, because the majority of its heart attack patients are transferred from other hospitals. Most come from Culpeper Regional Hospital in Culpeper and Augusta Medical Center in Fishersville. Some arrive from as far away as Bath, Page and Danville counties.

Transferees accounted for 64 percent of U.Va.'s ST-segment elevation myocardial infarction patients in 2006, 69 percent in 2007 and 57 percent so far this year.
 
The total number of ST-segment elevation myocardial infarction patients treated at U.Va. was 171 in 2006, 151 in 2007 and 137 to date in 2008.
 
Ragosta says that U.Va. has a strong institutional commitment to the American College of Cardiology and American Heart Association metrics.

"We're committed to delivering top-quality care to all of our patients though a systems-based approach," he said. "I believe our door-to-balloon times should assure patients that they will receive an extraordinary level of care here."

This story originally appeared on the U.Va. Health System Web site.