Waiting list is not a good option for heart attack patients – Jamaica Observer

One of the most troubling things we encounter in the health care system in Jamaica is the concept of waiting list.

Many patients in need of life-saving care are sometimes put on a waiting list' especially in the public system.

While this system appears normalised, it is sub-optimal for many critical conditions especially for patients with heart disease. According to the US Centers for Disease Control and Prevention (CDC), approximately every 40 seconds an American will have a heart attack. Every year, 805,000 Americans have a heart attack, 605,000 of them for the first time.

The data for Jamaica is uncertain but can be estimated by population size and risk factor prevalence. Using the known data from the USA and extrapolating from the population, we estimate that as many as 7,340 Jamaicans may suffer from heart attacks each year. In a paper published in 2010 in Research Reports in Clinical Cardiology, Ferguson et al estimated that based on self-reporting, about 12,000 Jamaicans are living with a history of heart attack, mainly in the age range of 55-74 years. This is most likely significantly underestimated as self-reporting is notoriously inaccurate and will not sufficiently account for under-diagnosis and health literacy.

For patients with heart attack, waiting for intervention is not an acceptable option. There is a strong association between time to intervention and risk of death in heart attack. Even a few minutes delay could result in devastating outcomes including death or major complications. Patients with unstable heart disease or heart attack need immediate attention.

Speed saves lives and speed equates to improved quality of life. Waiting list is not an option for a heart attack patient that needs an emergent procedure to see the blocked arteries (angiogram) or a procedure to open the blocked artery (angioplasty and stent placement) or sometimes open-heart surgery.

A heart attack occurs when a plaque resulting from a build-up of fat, cholesterol and other substances ruptures and forms a clot, blocking flow. This interruption in blood flow can damage or destroy heart muscle leading to chest pain, heart failure or death if not immediately addressed. A heart attack can lead to death if appropriate treatment is delayed. Current recommended treatment for heart attack is immediate procedure to identify the blocked heart vessel and proceed to open the vessel. Other medications should be administered based on the overwhelming medical evidence. Waiting list is not an option for heart attack. Immediate intervention is warranted.

Door-to-balloon time (D2B) refers to the time it takes for a heart attack victim to receive a treatment called balloon angioplasty from the moment they walk through the hospital doors. Ideally, heart attack victims should be set and ready to undergo balloon angioplasty within 90 minutes of walking through the hospital door, if not sooner. This procedure is most effective within the 90-minute time frame before permanent damage to the heart has occurred. A review of patients seen at the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital with heart attack over the past 36 months show that we have been able to accomplish a mean door-to-balloon time of only 65 minutes, significantly better than many international centres of excellence for cardiovascular diseases.

Common heart attack signs and symptoms include:

Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back, sometimes associated with cold sweat.

Shortness of breath

Fatigue

Light-headedness or dizziness

Nausea, indigestion, heartburn, or abdominal discomfort

If you or someone you know is experiencing any of these symptoms and you think you or they might be having a heart attack, please seek emergency medical assistance, have someone drive you to the nearest heart hospital and demand immediate attention. This is how lives are saved.

At the heart hospital, immediate treatment will likely include coronary angioplasty and stenting after a diagnostic coronary angiogram: coronary angioplasty and stenting. In this procedure, also known as percutaneous coronary intervention (PCI), doctors guide a long, thin tube (catheter) through an artery in your wrist or groin to identify any blocked arteries in your heart. If you have had a heart attack, this procedure should be done immediately after a cardiac catheterisation/coronary angiogram, a procedure used to find blockages.

The catheter has a special balloon that, once in position, is briefly inflated to open a blocked coronary artery. A metal mesh (stent) with slow releasing drug is inserted into the artery to keep it open long term, restoring blood flow to the heart.

Coronary artery bypass surgery. In some cases, doctors perform emergency bypass surgery at the time of a heart attack, preferably after three to seven days to allow your heart time to recover from your heart attack

Bypass surgery involves sewing veins or arteries in place beyond a blocked artery, allowing blood flow to the heart to bypass the narrowed section.

You will likely remain in the hospital for several days after blood flow to your heart is restored and your condition is stable.

Dr Ernest Madu, MD, FACC, FRCP Edin is Professor of Cardiovascular Medicine and Chairman of the Heart Institute of the Caribbean & HIC Heart Hospital, 23 Balmoral Avenue, Kingston, Jamaica. Contact: emadu@caribbeanheart.com. Phone: 876-906-2105 to 2108

Now you can read the Jamaica Observer ePaper anytime, anywhere. The Jamaica Observer ePaper is available to you at home or at work, and is the same edition as the printed copy available at http://bit.ly/epaper-login

Read more:
Waiting list is not a good option for heart attack patients - Jamaica Observer