Tamil Nadu model drastically reduces response time in heart attack care


A unique model of heart attack care has brought down the time taken respond to cardiac episodes from 900 minutes to 170 minutes in Tamil Nadu.
The landmark study, reduces the symptom-to-door time by effective, early and rapid reperfusion — restoring blood flow through blocked arteries, typical after a heart attack.
The year long study has been funded by the Indian Council of Medical Reseach (ICMR) and the results were published online on Wednesday in the latest issue of the Journal of the American Medical Association (JAMA, Cardiology).

Primary PCI

Traditionally, a heart attack is treated by two strategies of re-perfusion. If a patient arrives at a hospital equipped with a catheterisation laboratory or ‘cath lab’, a procedure known as Primary PCI is performed — an urgent balloon angioplasty.
The patient is then ‘Thrombolysed’ — treated to dissolve clots in blood vessels, improve blood flow, and prevent damage to tissues and organs before being discharged.
In the new model, STEMI India, a not-for-profit organisation, set up by Dr. Thomas Alexander of Kovai Medical Central and Hospital (KMCH) Coimbatore, and Dr. Ajit Mullasari of Madras Medical Mission in Chennai, use the pharmaco invasive strategy, which can be administered in any small hospital or even in the ambulance.

Manpower deficit

“Any heart attack treatment programme should consider the huge manpower and infrastructure deficiencies that exist in India. Blindly following the American or European system would not be feasible in this country,” said Dr Alexander, an interventional cardiologist.
The Classic STEMI India model has a hub hospital, where a cath lab is available and primary PCI is done for patients directly presented at these hospitals.
These are linked to peripheral spoke hospitals, where thrombolysis is done following which the patient is shifted within three to 24 hours to the hub hospital for invasive treatment.
Data was collected from the four hub hospitals and 35 spoke hospitals, before and after the implementation of the heart attack programme. The pre-implementation data collection was for an average period of 15 weeks and the post implementation period of 32 weeks.
A total of 2,420 consecutive patients presenting with heart attack (898 pre- and 1,522 post-implementation phases, respectively) were enrolled between August 2012 and June 2014.
As a result of the study, there was a steep increase in the rural poor using Below-Poverty-Line (BPL) insurance schemes to access the STEMI system.
The numbers went up from 0 % to 60%. Further, the STEMI model resulted in an absolute mortality reduction of 3.4%, said the researchers. Investigators of the study are meeting with State governments to scale up the model in other parts of the country. “We are starting with States that have a basic ambulance service and a State government run insurance programme,” said Dr S. Meenakshi of the ICMR.

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