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Heart Attack on the Fast Track

 

When a person is felled by a heart attack, the quicker the patient can get to the care of a cardiologist, the better the chance for survival. To that end, Flagstaff Medical Center has implemented a new program that puts a heart attack victim on the fast track.

Called the STEMI Program, its aim is to bypass the emergency room and get the patient to a cardiologist as soon as possible.

“Basically, the point of the heart attack program is to minimize the time lost between the identification of a patient having a heart attack and their definitive care,” said Dr. Eric Cohen, interventional cardiologist and medical director of Heart & Vascular Center of Northern Arizona.

The way the new program works begins in the field when emergency medical service personnel declares the patient is having a heart attack, which puts the program into motion. The patient bypasses the emergency room and is taken directly to the catheterization lab where a cardiologist and staff are waiting. The lost time waiting for the physician to see the patient is reduced considerably, which allows a better outcome for patients.

One of the most common types of heart attack that requires immediate attention is called a STEMI, or ST segment elevation myocardial infarction. When this happens, the coronary artery or arteries that provide blood to the heart are blocked and the heart muscle starts to die.

The blockage must be cleared as soon as possible by a procedure known as balloon angioplasty or stent, performed in a cardiac catheterization lab by a cardiologist. The sooner the balloon is inserted, the better chance of survival for the patient.

In Flagstaff, the STEMI program is a little more than six months old, but nationally it has been in place three to four years, Cohen said. “The national standard is to get the patient to the cath lab in less than 90 minutes, “he said. “If an EMS declares it an event, the patient is taken directly to the cath lab bypassing the ER. The record time at FMC so far is 25 minutes.”

In that instance, he said, a patient developed chest pains that were followed by a cardiac arrest in the Flagstaff Mall. EMS was there in five minutes and resuscitated the patient and declared an event.

“I was in the lab with a team with no delay on our part on arrival. We opened the artery with a stent procedure,” Cohen said. “This was a team effort. She would not be alive.”

He said the program has been put into motion more than 20 times since August 7, which includes not just Flagstaff residents, but people from outlying areas who are brought in by air or ground from more remote locations.

“We are saving not just lives, but we are changing the mortality rate. We are changing the outcome. The longer an artery is blocked, the more muscle is lost.”

Cohen said the more heart muscle that can be saved is directly related to the quality of a patient’s life.

Cohen worked in Birmingham, Ala., where the hospital had a program like this for several years. “When we were asked to put something like this together, I was already familiar with what it looked like.”

He said the program works well in Flagstaff because it is the only Level One Trauma Center north of Phoenix. In large metropolitan areas, emergency personnel have several choices of where to take a patient. “We have the most highly evolved program in Arizona. When the EMS activates the program it cuts a great deal of time. It’s a big deal.” FBN

 

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