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HMH program strengthens defense against heart attacks

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Goal is to perform balloon angioplasties before 60 minutes pass

By Marty Finley

Hardin Memorial Hospital says it is serious about heart attacks, pointing to a new initiative it believes will save lives and improve the quality of care for heart patients.

HMH officials said a program developed to shrink the wait period between a patient’s arrival and the start of a balloon angioplasty has exceeded expectations and met markers quicker than anticipated.

The hospital has developed its own primary percutaneous coronary intervention program, which went live Jan. 7. The program treats ST-elevation myocardial infarctions (STEMI), a severe form of heart attack caused by blockage to one or more major arteries. The hospital’s ultimate goal is to shorten the duration for the start of the balloon angioplasty, performed by running a deflated balloon along a catheter through the skin and to the point of blockage, where it is inflated to open vessels and improve blood flow.

Physicians recommend a door-to-balloon time of no more than 90 minutes, but the hospital is aiming for an average of 60 minutes for patients under the program.

John Horvath, director of the cardiovascular service line at HMH, said the program admitted 15 patients since going live, seven of which met all the standards for treatment under the program. For those seven patients, he said, the average door-to-balloon time was 63 minutes, which he described as remarkable considering the youth of the program.

“I’m surprised,” Horvath said. “… That’s very awesome.”

A team of physicians, nurses, administrators and EMS officials involved in each step of the primary PCI program all agreed they did not expect the hospital hit this benchmark so early.

In one specific case, Horvath said, the time between contact with Hardin County EMS in the field and the angioplasty did not exceed 71 minutes. To put this in perspective, the standard from medical field to balloon is less than two hours, said Dr. Prabodh Mehta, a local cardiologist.

Of the eight patients identified by the hospital but not directly treated through the program, Mehta said they received faster and better care because of the program’s existence.

Mehta said STEMI cases make up 2 to 5 percent of all heart attacks, but rank among the most intense. Physicians treat these cases with clot-busting drugs and a balloon angioplasty, or the more direct approach now being sought by HMH of moving directly to balloon angioplasty. Both approaches have proven credible forms of treatment, Mehta said, but the primary PCI approach has shown to be slightly more successful over the long term. There are limitations for the primary PCI approach at smaller or rural hospitals because resources are lacking, he said.

HMH saw value in creating its own primary PCI program and assigned a multidisciplinary team across the hospital, in coordination with Hardin County EMS, to pool its resources and create a structured approach to ensure the best care could be provided for those patients, according to officials.

“It takes a lot of effort, but we value those patients,” Mehta said.

The diagnosis of a STEMI originates in an ambulance with a 12-lead electrocardiogram, which is transmitted directly to the hospital from the ambulance via Wi-Fi, according to HMH. Once received, the EKG is reviewed and confirmed for STEMI and an alert notification is sent out to the STEMI team by the ER. The team assesses the patients once they arrive before transporting them to the cath lab for the procedure.

Since the launch, Mehta said the communication between departments has tremendously improved, fueled by a desire to give the patient the best care possible. Mehta said time is muscle and the longer treatment is delayed, the more heart muscle is damaged.

“The more time we save, the better off the patient will be,” he said.

The hospital has invested money into the program for equipment upgrades, but Mehta said this is one instance in which there is no expectation of increased revenues but simply a desire to promote better care, even if it’s only by a fraction.

“Our goal is not to do this for three or six months,” Mehta said. “We want to do this forever.”

Sharon Wright, a registered nurse and director of the Emergency Department at HMH, said the program is specified with roles clearly assigned for each member of the team in the hospital.

Ira Dyer, deputy director of Hardin County EMS, equated the number of people working on the program to a NASCAR pit crew, trained in different disciplines and working together quickly to ensure the car is running properly.

“It doesn’t matter how good you are at NASCAR if you can’t get out of the pits,” Dyer said.

Dyer said HMH is ahead of the curve when it comes to the program and, as it develops, outlying EMS providers will start bringing STEMI patients to HMH instead of bypassing Elizabethtown for Louisville.

Wright said HMH already has secured an agreement with LaRue County EMS for the program.

Dyer said the public can collaborate by understanding and recognizing signs of heart attacks and consulting with their physicians in advance. If a heart attack is expected, Dyer said, residents should not delay in contacting EMS for transport. Dyer and others discouraged patients driving themselves to a hospital because they not only risk injury to themselves but place other motorists in danger.

Michelle Murphy, director of marketing and public relations, said some ignore symptoms and even postpone care because of their hectic lifestyles.

“Everyone is really busy,” she said. “They think it’s other things.”

Wright echoed Murphy.

“Denial is the first symptom,” Wright said.

Marty Finley can be reached at (270) 505-1762 or mfinley@thenewsenterprise.com. 

Sign of a heart attack

Hardin Memorial Hospital warns some residents may be unaware they have heart problems until they experience the symptoms of a heart attack. If you experience one of the following symptoms, you are urged to seek emergency care immediately.

Common symptoms and warning signs of heart attack:

  • Chest pain or pressing discomfort
  • Shortness of breath
  • Dizziness or lightheadedness that may be accompanied by nausea or vomiting
  • Excessive sweating
  • Anxiety and palpitations

In certain individuals, such as diabetics, symptoms of a heart attack may manifest themselves in different ways, said Ira Dyer, deputy director of Hardin County EMS. Likewise, heart attacks among women often present themselves differently than they do in men, he said. Michelle Murphy, director of marketing and public relations at HMH, said residents should consult with their doctors and assess their risk factors. For more information on heart disease and heart attacks, log on to www.hmh.net.

Source: Hardin Memorial Hospital