In January 2006, the American College of Cardiology (ACC) initiated the D2B Alliance. The purpose of the alliance is to reduce the time it takes for heart attack patients to receive cardiac care after they’ve been admitted to the hospital. The goal: 75% of STEMI patients will receive care within 90 minutes of admission.
What is STEMI?
STEMI is ST-Segment Elevation Myocardial Infarcation. The condition may also be called myocardial infarcation (MI) or acute myocardial infarcation. Commonly known as a heart attack, STEMI occurs when blood flow to the heart is interrupted. This interruption deprives the heart cells of oxygen, causing them to die. It is important to differentiate heart attack from other sudden heart conditions:
- Cardiac arrest: This condition occurs when the heart completely stops beating. It is sometimes, but not always, caused by a heart attack.
- Cardiac arrhythmia: An arrhythmia is an abnormality in the heartbeat. This condition can occur without any other heart problems.
- Cardiac failure: When the heart’s pumping action is impaired, the patient suffers cardiac failure. A heart attack can lead to cardiac failure.
When a patient suffers a heart attack, rapid care is essential. Without immediate care, the patient can suffer more serious consequences like cardiac arrest or failure. Studies have consistently shown that shortened times to treatment significantly improve survival rates for heart attack patients.
The D2B Alliance
In recognition of the significance of reduced wait times, the ACC implemented the D2B Alliance. Participating hospitals commit to making rapid care for STEMI patients a priority and use evidence-based strategies to improve D2B times. They aim to treat 75% of STEMI patients within 90 minutes of admission to the hospital.
D2B stands for “door to balloon.” The “door” is when patients enter the door of the hospital. The “balloon” refers to the balloon that doctors generally use to treat heart attack patients. The two most common D2B procedures are angioplasty and stenting. During an angioplasty, the doctor inserts a catheter through a major vein and into the heart. A balloon is then inserted through the catheter and inflated. Inflating the balloon dislodges plaque and other blockages from the artery walls, allowing the blood to flow properly through the heart. If the unblocked artery appears weak or unstable, the doctor may insert a stent (a small mesh tube) to keep the artery open. These procedures take place in a facility known as a catheterization lab, or cath lab for short.
In order to ensure that patients receive this treatment as rapidly as possible, hospitals that participate in the D2B Alliance implement several strategies:
- An ED physician activates the catheterization lab.
- One call activates the catheterization lab.
- The catheterization lab is ready within 30 minutes of activation.
- All physicians and administrators receive prompt data feedback.
- Senior management makes D2B times a priority.
- A team-based approach is used.
These six strategies were chosen because they have been scientifically proven to significantly improve D2B times. Some hospitals may go beyond these guidelines and use additional strategies, such as having a cardiologist on duty at all times.
Why not aim for 100% of patients treated in 90 minutes? Some patients will always face delays that do not arise from quality of care. These include uncertainty about diagnosis; the presence of other life-threatening conditions that must be treated first; obtaining informed consent; and anatomical challenges such as arterial lesions. The ACC recognizes that these delays are inevitable—and a regular part of providing outstanding care.
All patients—and especially those who are at increased risk of heart attack—should take the time to research hospitals in the area and learn which facilities are part of the D2B Alliance. In case of a heart attack, the information could be a life saver.