As seen in the Daily Herald
Published February 4, 2009
By Janice Youngwith

"Each year thousands of heart attack patients fail to receive the care they need in a timely fashion," says David Cooke M.D. president, American Heart Association, Midwest Affiliate. "When it comes to treating heart attacks time is muscle."

In hopes of speeding treatment, the American Heart Association recently launched a multidisciplinary community-based initiative, Mission: Lifeline™ designed to improve the system of care for all heart attack patients.

"Some heart attacks are more severe than others and their consequences more deadly," reports Dr. Cooke, who has served as an American Heart Association volunteer for more than 25 years. "One of the most deadly occurs when the heart is completely blocked The faster an artery is unblocked, the better the chance of survival."

According to the American Heart Association an estimated 920,000 new and recurrent heart attacks occur every year.

"We believe emergency medical services, emergency departments and hospitals can save more lives if they work together to deliver the right kind of care, quickly," Dr Cooke adds. "By working together, we can provide heart attack patients who call 911 with an express ticket to facilities capable of delivering rapid, skilled treatment."

Dr. Cooke, a past recipient of the American Heart Association's C'oeur d'Or Heart of Gold award explains that specialists know how to treat the most serious type of heart attacks known as ST-elevation myocardial infarctions (STEMI) and know that victims need help in minutes, not hours.

"But making sure that help happens requires assessing and possibly changing our current system of treating these patients," he says.
 According to the American Heart Association, almost 400,000 people suffer from a STEMI heart attack each year.

He points to findings of a recent Harvard advisory working group reporting that up to 30 percent of heart attack patients suffering from a completely blocked artery do not receive any treatment to restore blood flow.

For those heart attack patients receiving treatment, Dr. Cooke reports fewer than 50 percent receive clot busting drugs within 30 minutes and only 40 percent are treated with a preferred door-to-balloon time within 90 minutes as recommended by the American College of Cardiology/American Heart Association guidelines.

"Clearly two thirds of STEMI patients fail to receive the best available treatments to restore blood flow," he notes.

To clear blocked arteries, specialists often turn to percutaneous coronary interventions (PCI) which encompasses procedures such as angioplasty, stenting and more - all with the goal of restoring blocked blood flow as quickly as possible. Using a small catheter inserted into the blocked area of the artery, a balloon may be inflated to reopen the artery and restore flow. After clearing blockage, a stent may be used to prop open the artery to maintain blood flow.

Of the nearly 5,000 acute care hospitals in the United States, about 1,700 have heart catheterization laboratories and only 1,300 are capable of performing angioplasty to open blocked arteries.

"Today local and state Mission: Lifeline™ task forces are being convened across the country to assess the current state of STEMI care and identify opportunities to enhance STEMI systems of care," reports Phil Aulbach senior Mission: Lifeline™ director, American Heart Association, Midwest Affiliate.

"The good news is that there are some excellent STEMI systems at care in areas in the Midwest such as Minnesota and some areas of suburban Chicago that serve as potential models and collaborators with areas that have gaps in their systems of STEMI care."

Aulbach says the ultimate goal of Mission: Lifeline™ is to improve outcomes for all heart attack (STEMI) patients, regardless of geography, by improving time to treatment for opening the artery. Ultimately, he says, Mission: Lifeline™ objectives play a key role in helping the American Heart Association meet and exceed its goal of reducing the death rate from coronary heart disease and stroke by 25 percent by the year 2010.

Statewide, he says, in 2008 the American Heart Association, American College of Cardiology and Region V of the U.S. Public Health Services held the first Illinois STEMI conference bringing together more than 100 physicians, nurses, EMT/paramedics, administrators and other allied health professionals. Ongoing discussions among various provider groups continue mat dialogue to establish a statewide system of care based on strong scientific evidence.

Both Dr. Cooke and Aulbach caution that multiple factors are at play in determining patient treatment time. "For patients, the biggest challenge may be knowing and recognizing heart attack warning signs and recognizing the urgency of calling 911." Dr. Cooke says. "For physicians, it means primary care and specialists need to work together and collaborate on care from the moment the patient enters the emergency room, and for first responders it means EMS vehicles must be equipped with the equipment to determine what type of heart attack is occurring."

Dr. Cooke explains that the STEMI type of heart attack often is only able to be determined by a 12-lead electrocardiogram (ECG) in each paramedic rig.

"This kind of heart attack kills more than any other, although it can be diagnosed quickly when EMS personnel have the right equipment and training," he notes. "If ambulances have the most effective equipment available, paramedics can determine the seriousness of the condition and ensure that heart attack victims receive appropriate treatment quickly."

On the local front, Dr. Cooke applauds many local paramedic teams and suburbs whose paramedics have 12-lead ECG capabilities on board.

 "Many suburbs like Wheaton, Winfield, West Chicago and Carol Stream are already ahead of the curve and using this technology," notes Dr. Cooke, who also serves as vice president of Quality & Safety at Central DuPage Hospital, Winfield "But if individuals don't take the initiative to call 911 at the very earliest opportunity, all the technology in the world won't make a difference."

Ultimately, they say, time to treatment is the most critical when it comes to saving hearts and saving lives.

Heart attack warning signs

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes or that goes away and comes back. If can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms may include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest discomfort.
• Other signs may include breaking out in a cold sweat, nausea or lightheadedness

The most common heart attack symptom for both men and women is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms particularly shortness of breath, nausea, vomiting and back or jaw pain. -Source American Heart Association