| Cardiologist Thomas Aversano, M.D. |
“Corner any cardiologist and ask, ‘How would you treat your father if he had an acute MI?’ and in nine out of 10 cases, the answer focuses on angioplasty at a center that knows how to do it well,” maintains cardiologist Thomas Aversano, M.D. From his considerable experience with heart attack patients, Aversano believes that angioplasty often has an edge over the popular thrombolytic treatment, tPA. He says studies at major medical centers suggest this as well. The glitch is that regulations in most states forbid primary angioplasty in places where people are treated for acute MI, their local community hospitals, unless those hospitals offer cardiac surgery. (The laws anticipated potential complications after the procedure.) In local hospitals that do offer the procedure, what’s worrisome, says Aversano, “is the fact that we don’t know at all how their primary angioplasty measures up.” So, Aversano has gotten waivers from state health departments to set up model community primary angioplasty programs. Aiming for hospital standardization—no mean feat—he has assembled a massive team of Hopkins cardiologists, nursing coordinators, public health researchers and other experts. They evaluate existing small-hospital programs and upgrade the skills of their personnel, if necessary, to meet national angioplasty standards. “We take in hundreds of nurses and technical staff from smaller hospitals,” explains Aversano, and train them via lecture and hands-on observation, eight hours of which is spent observing in Hopkins’ cath lab. Teams already performing elective angioplasties in community hospitals carry out at least 25 primary versions, under watchful eyes. In addition to training nurses, the program’s nursing coordinator at Hopkins helps hospitals create or improve care plans for patients, a tactic Aversano says “makes a night and day difference in outcomes.” Evaluators comb the small hospitals for logistical hazards like chronic delay in transfers from emergency rooms to cath labs. And they help assess outcomes to make sure they accurately reflect the hospital. “The pressure to offer primary angioplasty is getting stronger throughout the country,” says Aversano. “This study will make sure that when programs are set up, they’re the best they can be.” Hopkins Medical News, Fall 1998
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