For all the spectacular advances in cardiology, heart surgeons will still tell you that nothing determines the treatment outcome for a heart attack patient as much as the maxim “time is muscle”. In other words, survival rates of a heart attack are decided by how quickly a patient reaches a cardiac care hospital to arrest the extent of heart muscle damage.
Against the backdrop of an estimated three million heart attacks happening every year in India, a collaborative initiative, to develop an integrated response to the management of heart attacks, is gaining depth and reach in Tamil Nadu.
Spearheaded by STEMI-India, a not-for-profit collective of interventional cardiologists affiliated to its Europe-based parent organisation, the initiative involves government, private-public hospitals and international experts.
This year, STEMI-India looks to build on the lessons from a pilot programme launched at Coimbatore, over a year ago, and add capacity to its hub-and-spoke model of integrated emergency care for heart attack patients.
The pilot project at the Kovai Medical Centre Hospital on 84 patients involved public education, training doctors and support staff in advanced STEMI (ST Elevation Myocardial Infarction) management and developing linkages with ambulance service providers.
The interventions resulted in virtually halving the time from onset of chest pain to arrival at a hospital, to under three hours as against national estimates that it takes an average of six hours for a chest pain patient to report to a hospital.
Based on this experience, STEMI-India is extending the hub-and-spoke model with Stanley Medical College, CMC, Vellore and the Madras Medical Mission serving as the tertiary heart care facility for small and medium-sized hospitals in their respective regions.
“We seek a fundamental attitudinal change where patients developing chest pain will choose the 108 ambulance option over public transport or even private vehicles,” said Mullasari Ajit, cardiology director, Madras Medical Mission.
Doctors point out that several life-saving measures such as administering clot busters that can be launched, either at a small hospital or in the ambulance, well before a patient reaches a cath lab-equipped hospital.
Dr. Mathew Samuel Kalarickal pointed out that this was why the ‘108 Ambulance’ service of the Emergency Management and Research Institute was one of the key partners of the programme.
STEMI-India has also developed, for use in ambulances, a low-cost laptop-like device that can scan ECG and transmit the image to a hospital well in advance of the patient's arrival. “Time really is muscle in the provision of quality cardiac care,” said Miles Dalby from Royal Brompton and Harefield NHS Foundation Trust, UK.
Apart from patient education, the quality outcomes in heart attack management are determined by pre-hospital, in-hospital and post-hospital care.
“The ideal we aim for is to get all the three elements to work together,” Dr. Dalby said.
“Even in Europe, there is lack of uniformity in access to PCI, or Percutaneous Coronary Intervention. Our goal is to increase patients’ access to life-saving PCI,” said Zuzana Kaifoszova, Stent for Life, Czech Republic.
“The structured management of heart attacks that we evolve would be replicated across the State and the country,” Dr. Ajit said.
Dr. Kalarickal said an important benefit of involving the State was that a provision had been worked out to provide insurance cover (under the Chief Minister’s Comprehensive Health Insurance Scheme) for heart attack patients participating in the pilot project.
Dr. Ravi Nair from Cleveland Clinic, US, said the lessons from the pilot studies would be more appropriate than the Western experience for demographies that share similarities with India.
