Texas Health Dallas Cardiac Experts Collaborate with Duke University Medical Center

DALLAS —Tens of thousands of North Texans enjoy small-town life in rural communities outside the hustle and bustle of downtown Dallas. These far-away suburbs offer a quiet, simple life enjoyed by families and retirees who want a break from the hectic buzz of the big city.

Second from right, Zoe Terral, director of invasive and non-invasive cardiology at Texas Health Dallas, discusses heart attack care with Texas Health Dallas clinicians and cardiac experts from Duke University Medical Center.

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But living in these communities also comes with a price: residents are far away from major medical centers with advanced interventional cardiac procedures that can mean the difference between life and death.

“As the Metroplex expands, there are more and more residents further away from the hospitals that have these specialized heart procedures,” said Dr. John Harper, a cardiologist on the medical staff at Texas Health Presbyterian Hospital Dallas, where cardiac patients are brought from all corners of the region. “The challenge is that there inevitably will be people in these remote suburbs who suffer heart attacks — and how quickly they’re transported to hospitals like ours and properly treated impacts their recovery.”

Texas Health Dallas recently held a special two-day conference with emergency-response experts from Duke University Medical Center, which pioneered many of the national standards for efficiently transporting heart-attack patients from small, outlying hospitals to major medical centers.

Duke has published research about their acute heart attack response system for patients who live in rural communities outside Durham, North Carolina. The Duke team visited several Texas Health Resources hospitals, including Texas Health Dallas, Texas Health Kaufman, Texas Health Allen and Texas Health Rockwall.

While the cardiac catheterization laboratory at Texas Health Dallas is where many heart attack patients are ultimately treated, a smooth transfer system from the smaller, regional hospitals is a key link in the success of the system.

“Every step in the process — from the paramedics in the field, to the local hospital, to how quickly we transfer them here and get our on-call catheterization team in place — impacts how quickly the patient is treated,” said Jon Gardner, administrative director of the Heart & Vascular service line at Texas Health Dallas.

From left, Paula Spencer, R.N., Texas Health Dallas' chest pain coordinator; Jenny Underwood, R.N., a Duke critical care specialist; and Texas Health Dallas ED charge nurse Sharon Grewing discuss the flow of cardiac patients when they arrive in the ER.

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The weekend conference involved an analysis of the system for treating patients who suffer a STEMI (ST-elevation myocardial infarction). A STEMI is a common type of heart attack that involves a blood flow problem in the heart.

The circulation of blood can be interrupted by a collapsed artery or blood clot. This condition, which can cause permanent damage to the heart muscle in a matter of minutes, is one of the leading causes of death in the United States. The Texas Health Dallas initiative in North Texas is called STEER (ST Elevation Emergency Response).

“There’s a strong passion for this program among all of us here at Texas Health Dallas because we know how much it impacts the lives of our patients,” said Paula Spencer, R.N., the chest pain coordinator at Texas Health Dallas.

Many times, the best way to treat the heart attack is with an interventional cardiac catheterization procedure that involves inserting a tiny wire into a leg artery. The wire is guided through blood vessels to the site of the blockage.

A tiny balloon at the tip of the wire is then inflated to open the coronary artery, and a small metal stent or mesh is often inserted into the artery to help it stay open. The procedure, called percutaneous coronary intervention, is not offered at all hospitals.

The amount of time that elapses from the moment the patient crosses the threshold of the first hospital, even if that facility is in Rockwall or Kaufman, to the time the balloon is inflated to restore blood flow at Texas Health Dallas, is called door-to-balloon (D2B) time.

Major clinical studies, endorsed by the American Heart Association, have shown that treating heart attack patients within 90 minutes of arrival significantly reduces damage to the heart muscle.

“The importance of this conference is that it’s another example of the commitment by physicians on the hospital’s medical staff, the EMS personnel, and our emergency room and cardiovascular staff at Texas Health Dallas to provide evidence-based health care in an efficient, quality way,” said Dr. Ken Saland, an interventional cardiologist on the medical staff at Texas Health Dallas.

Numerous patients brought to Texas Health Dallas with a STEMI from areas outside Dallas city limits have been cared for in under 90 minutes.

“Our system is efficient, but the goal is to always improve and to always look for ways to get better at what we do,” said Dr. Sean Black, an emergency physician at Texas Health Dallas. “It’s important because we know that it’s not simply a quick time we’re looking to achieve; we know that the sooner you treat a heart attack patient, the better chance you have to save heart muscle and, in many cases, save lives.”

The Duke team looked at every aspect of treatment of “remote STEMI patients” at several Texas Health Resources hospitals around Dallas. The emergency rooms at outlying hospitals play a critical role in the process, since that’s where the heart-attack patients typically arrive first.

“That’s the ‘front door’ of the hospital, so providing rapid cardiac assessments and efficiently communicating and implementing the remote STEMI transfer system is critical to achieving the best care for patients,” said Jenny Underwood, R.N., a crticial care specialist at Duke who was on hand to share her knowledge of remote STEMI care with the Texas Health group.

“I think there’s a strong system in place here in the North Texas area, but there are always opportunities to improve how things are done,” said Dr. George Adams, a cardiologist on the medical staff at Duke University Medical Center who assessed the North Texas system. “There are a few hints we can pass on to them, and there are some things we can learn from them.”

“Preserving more heart muscle helps the patient survive the heart attack and improves the long-term survival and quality of life for patients,” said Zoe Terral, director of invasive and non-invasive cardiology at Texas Health Dallas. “It’s rewarding every time we’re able to effectively care for someone suffering a heart attack.”

About Texas Health Presbyterian Hospital Dallas
Texas Health Presbyterian Hospital Dallas is an 866-bed acute care hospital and recognized clinical program leader, having provided compassionate care to the residents of Dallas and surrounding communities since 1966. US News and World Report has ranked Texas Health Dallas among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Dallas has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information, call 1-877-THR-WELL, or visit www.TexasHealth.org.