Deadly
Heart Attacks Need Quick Treatment
The American Heart Association
(AHA) is launching a community-based program to reduce the toll
of the deadliest kind of heart attack.
The attack is total blockage of a heart artery, which
can be fatal unless treated quickly in one of two ways.
Those options: medication therapy to clear away a clot
blocking the artery, or angioplasty, the insertion of a balloon to push the
artery open.
In technical terms, the attack is called an ST-elevation
myocardial infarction (STEMI), referring to a feature seen on an electrocardiogram
(ECG or EKG).
And those treatments must be done quickly - ideally, within
30 minutes for clot-dissolving medication treatment, and within 90 minutes
for angioplasty.
Fewer than half of all STEMI patients get the right treatment
at the right time, says Dr. Alice Jacobs, at Boston University.
Dr. Jacobs, past president of the AHA,
says the new program is called "Mission Lifeline."
The program's emphasis will be to improve on the current
treatment statistics, notes Dr. Jacobs.
"Thirty percent of STEMI patients do not get clot-busting
drugs," she says. "Twenty percent are not candidates for clot-busting drugs
and, of these, 70 percent do not get angioplasty."
A major part of the effort will be devoted to establishing
systems to transport STEMI patients to hospitals that are equipped to do
angioplasty.
"Angioplasty is better than clot-busting treatment, even
when transportation is needed," says Dr. Jacobs. Only 25 percent of US hospitals
have the catheterization facilities that allow them to do emergency angioplasties.
But another major component of the program will be devoted
to teaching persons in general to call 911 for emergency help when they experience
symptoms of a heart attack.
About half of all heart attack patients now drive themselves
to a hospital or are driven.
This approach adds up to a shocking loss of time when
they could be getting emergency therapy, and the hospital could be preparing
for their arrival, says Dr. Tim Henry, at the Minneapolis Heart Institute.
The Institute
has a program that the AHA hopes
will be a model for rural areas.
It ties together more than 100 hospitals, most of which
cannot do angioplasty. There had been doubts about whether patients could
be transferred quickly enough for angioplasty to be done on time.
But, Dr. Henry
says, "We now have 31 hospitals trained
up to 60 miles away, then out to 210 miles away. A 60-mile transfer can be
done in 95 minutes, and a 200-mile transfer can be done in 120 minutes."
The death rate is currently 4 percent, says Dr. Henry,
a figure he says is impressive because 15 percent of those transferred are
over 80 years of age.
Comparable local programs in areas such as North Carolina
and California also can serve as models, says Dr. Jacobs.
The program will start with individuals at risk of a heart
attack, say Drs. Henry and Jacobs. It is important for those people to seek
trained help as quickly as possible by calling 911.
Always consult your physician for more information.
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