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  • Region's heart-attack treatment is ahead of the curve

    Success sets a standard for other hospitals to meet
  • Southern Oregon's speedy response to heart attack victims puts the region at the forefront of a new national treatment initiative known as "D2B."
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  • Southern Oregon's speedy response to heart attack victims puts the region at the forefront of a new national treatment initiative known as "D2B."
    That's medical shorthand for the goal of getting patients from the door of the hospital to opening a blocked artery with a tiny balloon within 90 minutes. D2B is being promoted by the American College of Cardiology, the American Heart Association, but Southern Oregon cardiologists started doing it well before it became a treatment objective.
    Rapid treatment is important because the longer the heart muscle is deprived of oxygen, the more it's damaged.
    "Time is muscle," said Dr. Brian Gross, the Medford cardiologist who encouraged local hospitals and physicians to look for ways to hasten treatment for heart attack patients.
    Standardizing procedures for treating heart attacks the way it's been done here helps shorten the time before treatment begins, said Dr. Joaquin Cigarroa, associate professor of medicine and director of cardiac catheterization labs at Oregon Health & Science University in Portland.
    Cigarroa said streamlining treatment systems to respond faster will save more lives in the next five years than any new treatments or drugs. "It's not going to be stem cells," he said. "It's not going to be new therapies or new stents.
    "We have to identify (heart attack patients), rapidly triage, and initiate care," he said.
    Gross said the arrangement works here in part because the community is large enough to have an adequate pool of physicians, but small enough that there hasn't been competition for cardiac patients. Larger communities, where numerous hospitals and cardiology groups are competing for patients, wouldn't necessarily let patients drive past a hospital to go to a regional treatment center.
    Cigarroa said larger communities where several hospitals compete for cardiology patients will have to decide how to divide patients, just as hospitals provide different levels of trauma care.
    To function properly, the system needs to have an "interventional" cardiologist available around the clock to insert a thin wire in a patient's artery and guide it to the blocked coronary artery, where the blockage is opened with a tiny balloon.
    Medford's five interventional cardiologists (Gross, Kent Dauterman, Todd Kotler, Mark Moran and Stephen Schnugg) have agreed to take extra "on call" time to ensure that one of them will always be available to serve heart-attack patients. That's in addition to the regular-call commitments of their practice groups.
    "We've made it our number one priority," Gross said. "We believe in this strongly enough that we will take extra-call."
    The extra commitment means one night a week, and one weekend in five, the interventional cardiologist on call has to stay close to home and keep his calendar essentially empty so he can get to the hospital within 10 to 20 minutes.
    "If we go somewhere with a spouse, we have to take two cars," said Dr. Todd Kotler. "If we go to a restaurant, we're really taking a gamble. If you have young kids (the physician) can't be the primary care provider. You can't have a glass of wine or a beer, and it not infrequently means getting up in the middle of the night for a heart attack."
    Gross said Southern Oregon's achievement already has gained national recognition. He's been contacted by prestigious institutions such as the Cleveland Clinic, and a national conference he attended last week opened with a tribute to the work here as a prime example of what can be accomplished.
    Reach reporter Bill Kettler at 776-4492 or e-mail:bkettler@mailtribune.com
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