The Need for Speed
Heart Attacks Demand Fast ‘Door-To-Balloon’ Times

Nov. 18, 2011, started out as a typical day for Richard Fleeman, who was turning 51 in a week. The Leesburg resident had just settled into his workday as a wholesale parts manager at BMW of Alexandria.

“All of a sudden, I wasn’t feeling right, like the flu was coming on,” Fleeman recounts. “I started having severe back pain in my lower back, my upper back and then my neck. It dawned on me: I’m having a heart attack.”

A co-worker drove him to Inova Alexandria Hospital’s Emergency Department. There, with just two words, “chest pain,” he set into motion a chain of responses that involved multiple hospital departments, physicians, nurses and technical staff.

Beating the Clock

A heart attack occurs when one or more of the coronary arteries that supply blood to the heart become partially or completely blocked, starving the heart muscle of blood, and causing possible heart damage or death. For patients like Fleeman, whose heart attack involved complete blockage, the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend patients receive lifsaving balloon angioplasty — an emergency artery opening procedure — within 90 minutes of hospital arrival. Known as door-to-balloon or D2B time, the ACC and AHA launched a nationwide initiative in 2006 to educate hospitals about the 90-minute goal. Inova Heart and Vascular Institute at Inova Alexandria Hospital joined the nationwide effort and committed resources to improving our D2B times.

Today, Inova Alexandria Hospital has exceeded the 90-minute goal with an average D2B time of 65 minutes, but the work continues. Every heart attack case is reviewed for areas of improvement; the hospital participates in a national hospital registry that shares best practices for reducing D2B; and it works with the AHA’s Mission: Lifeline project to train healthcare providers in the field.

For Fleeman, it took only 29 minutes from door to balloon. An interventional cardiologist performed an angioplasty and inserted a stent to open his one blocked artery. Two days later he went home in time to celebrate his 51st birthday and Thanksgiving. This year, he likely felt particularly grateful.

Heart Smart
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