Coronary heart disease (CHD) is the leading cause of death for both men and women in the United States. Approximately 1.2 million Americans a year suffer a heart attack. Nearly half of these people—or about one person every minute—dies each year, often in the emergency room or before they can get to a hospital.

The Heart Attack Project

In January 2003, physicians and heart experts from across the Sutter network joined forces and created a task force to standardize care for heart attack patients and improve their chance of survival and their quality of life. The task force developed a best practice model of care for patients based on the most advanced research available. An outreach campaign was launched detailing new care guidelines that promote consistent management and outcomes of heart attack patients.

Heart Attack Facts

• Over the past 20 years, the number of Americans discharged from the hospital with a heart attack (Acute Myocardial Infarction or AMI), as the primary diagnosis has increased 27 percent.
• Approximately two-thirds of these patients don’t make a full recovery.
• The majority under age 65 are able to return to work, yet AMI has become the leading cause of premature and permanent disability in the U.S.

Despite these grim statistics, research shows that timely and proper intervention can dramatically improve heart attack survival rates. When administered appropriately in the ER or hospital, ACE inhibitors and other medications and treatments play a major role in improving outcomes for heart attack patients. Quitting smoking and changing other lifestyle behaviors have also been shown to reduce the risk of future heart attacks and improve patient quality of life.

Anatomy of a Heart Attack
Heart attacks occur when blood flow to a portion of the heart is severely reduced or cut off. The result is death of heart muscle cells (called an infarct). Hardening and narrowing (atherosclerosis) of the coronary arteries that feed the heart is usually the underlying problem. In some cases, a blood clot blocks blood flow; other times, the narrowing is caused by atherosclerosis alone. Spasm of the coronary arteries may also cause a heart attack.

Project Goals

• Improve quality of care and outcomes for AMI patients.



• Ensure AMI patients receive timely evaluation and appropriate reperfusion (restoration of blood flow) and drug therapies in the ER and hospital.



• Promote appropriate use of ACE inhibitors and other medications and treatments that help reduce AMI-related disability and death.



• Order appropriate discharge medications and provide patient education materials, including smoking cessation information.

Heart Attack Patient Care Guidelines

Timely Diagnosis and Initial Treatment
Every minute counts during a heart attack. If the heart stops pumping blood, brain damage—or death—can occur within minutes. Patients arriving in the emergency room with a suspected heart attack require prompt clinical evaluation, including blood tests and an electrocardiogram (EKG), to determine the type of heart attack and to rule out other conditions that may mimic a heart attack. Upon arrival, all suspected heart attack patients should be given aspirin and heparin to treat and prevent blood clots and beta blockers to reduce blood pressure.

Restoring Blood Flow
Heart attacks occur when blood flow to a portion of the heart is severely reduced or cut off, usually due to a blood clot or hardening and narrowing of the coronary arteries (atherosclerosis). In the ER or hospital, the main goal of treatment is to unclog the blocked artery or arteries and restore blood flow (reperfusion) to the heart muscle as quickly as possible. This is done with thrombolytic drugs, angioplasty, or coronary bypass surgery. Thrombolytic drugs, such as stretopkinase or t-PA, given intravenously help dissolve blood clots and may prevent damage to the heart if given early enough. Angioplasty is a non-surgical procedure used to increase blood flow to the heart muscle. During the procedure, a thin tube (catheter) is inserted into a major artery in the leg or arm and guided into the blocked artery in the heart. A balloon on the tip of the catheter is then inflated to clear or widen the blocked artery. Sometimes a wire mesh tube (stent) is inserted inside the artery to keep it from collapsing after it has been cleared. The American College of Cardiology (ACC) and the American Heart Association (AHA) recommend that thrombolytic therapy begin within 30 minutes and angioplasty within 90 minutes of a patient’s arrival in the emergency room.

Discharge Medications and Treatment
Patients who survive a heart attack are at much greater risk of having another heart attack or some other cardiovascular disease than the general population. Research and established AMI treatment guidelines recommend that heart attack patients be prescribed a combination of medications upon discharge from the hospital. Most patients will need to take these medications for life to maintain their health and reduce the risk of future heart attacks. The most common medications include:

• Aspirin, which prevents platelets from clumping in the blood and forming blood clots that clog arteries in the heart.


• Angiotensin-converting enzyme (ACE) inhibitors that block the creation of an enzyme that raises blood pressure, constricts blood vessels, and causes salt retention.


• Beta-blockers to reduce the workload on the heart and lower blood pressure.


• Lipid-lowering drugs that lower cholesterol, the fatty substance in the blood that forms plaque and clogs arteries.

In addition to medication, substantial research shows that quitting smoking and making other lifestyle changes can also reduce the risk of future heart attacks and improve patient quality of life.

Clinical and Patient Education Tools
Several resources and educational tools have been developed to help physicians and other clinicians improve AMI care. For example, physicians can use specially made inpatient order sets to create treatment plans for patients identified or admitted to the ER or hospital with chest pain or AMI. The preprinted checklists provide physicians with the most up-to-date, evidence-based AMI treatment guidelines, including recommended tests and medications. Physicians are free to modify the templates as they see fit to meet a patient’s individual needs. Before they leave the hospital, heart attack patients receive a 26-page patient education booklet explaining their condition and what they can do to live a heart healthy life and help prevent future heart attacks.

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Updated February, 2008