Racing in relay: Real-world delays to heart attack treatment

Published December 22, 2021, 6:25 PM

by MB Lifestyle

Dr. Jose Paolo A. Prado
Interventional Cardiologist and AMI Program Director
The Medical City Ortigas

Ischemic heart disease continues to be the leading cause of death in our country, reaching 56.76 thousand cases from January to June 2021, according to preliminary estimates[1] from the Philippine Statistics Authority. The figure accounts for 18.7 percent of total deaths nationwide, far from the 10.2 percent share contributed by cerebrovascular diseases (ranked as the second leading cause of death), and from the 5.7 percent share contributed by COVID-19 cases (ranked as the fifth leading cause of death).

In ischemic heart disease (or coronary artery disease), coronary arteries become narrowed due to the build-up of cholesterol-rich plaque, a process seen in people who have high cholesterol levels, diabetes, hypertension, and those who smoke and have a strong history of heart disease. Once well developed, the plaques can rupture and blood clots can form within the artery, which can then lead to more severe and sudden blockages. This results in inadequate blood flow to the heart muscle, which may lead to permanent scarring and damage if the blockage is not opened within 60 minutes (the recommended international standard).

In short, a heart attack or an acute myocardial infarction (AMI) can happen instantly with or without warning signs or symptoms. When AMI happens, it then becomes a race with time to open the blocked artery in order to restore blood flow to the heart.

In all the time I have been with the AMI Clinical Care Program of The Medical City’s Cardiovascular Institute (CVI), I have always striven to communicate our guidelines to those

involved in the patient’s treatment: Time is muscle. Do not delay care. Yet it hasn’t escaped our notice how difficult it can be for both medical professionals and patients to eliminate all sources of delay, especially when a heart attack patient is needing emergency care.

Several studies have observed that since the start of the COVID pandemic, delays in seeking emergency care, particularly with heart attack patients, have been more prominent. The perception of far greater threats, such as COVID-19, or the financial burden of healthcare expenses, may be likely culprits.

This has led to patients presenting in a worse, more unstable condition, because significant damage to the heart has already occurred. When researchers from Israel looked at heart attack statistics in 13 large hospitals at the pandemic onset, they found that the average 180 minute time frame from the start of chest pain to the time the blocked artery was opened (via angioplasty procedure), was prolonged to 290 minutes. This is an average delay of almost two hours! Because of this delay, patients had more complications, such as heart failure and life-threatening heart rhythm irregularities.

While delays in definitive management of the heart attack are largely due to patient delay, a significant part may also be due to delays in hospital processes affected by strict lockdowns, as well as the reprioritization of hospital resources and staff to the COVID response. Having a well organized AMI Clinical Care program ensures that such hospital processes continue to function effectively.

With these factors in mind, we are realizing that the race against time when it comes to AMI is not something we can win through improved systems and processes alone—it is a marathon that requires both cooperation and continued communication between doctors and patients to succeed.

From frontlines back to the starting point

After proving continued compliance with the Joint Commission International’s standards for healthcare, the AMI Program of The Medical City recently secured its third certification as a clinical care program from the accrediting body last October. This is the only Heart Attack program in the whole country that has met the exacting standards of the JCI. This means that, even through the pandemic, with systems and procedures in place from the Emergency Department to the Catheterization Laboratory, our doctors have been able to safely accommodate heart attack patients once they are brought through our doors, and have their blocked coronary arteries opened within 60 minutes.

Ideally, all healthcare providers should be able to administer treatment for heart attacks as timely and as urgently as possible, so that more heart muscle can be saved, and both long-term damage and death can be prevented.

Of course, being able to receive treatment as fast as possible also relies on how quickly patients can respond to warning symptoms, and whether emergency care is available to them. In the event of an emergency, go to your nearest emergency room or call the designated hotlines in your area if you need help finding a hospital.

Lastly, the soonest and most timely cure for heart attack is always going to be prevention. It is also the most effective way of avoiding unanticipated high-ticket healthcare costs.  Many patients still believe that heart attacks only happen to those who are older or are obese, but the truth is, it knows no age or time on when to strike. Genetics plays the biggest role in increasing one’s risk factors, though we have also noticed the pandemic’s many restrictions and indulgences pushing younger professionals towards higher chances of getting heart diseases.

People who want to avoid heart disease and live a healthier and more productive life should focus on taking care of their bodies now more than ever. Eating right and finding time for exercise is the best recipe for longer and more sustainable health. Have regular check-ups, especially when you are already managing an existing heart condition or already have higher risk for heart disease.

And during a heart emergency, go to the nearest emergency room available. The quicker a medical professional can determine if it is a heart attack, the faster the response can be in either providing treatment or bringing you to a heart attack ready hospital like The Medical City.

Written by Dr. Jose Paolo Prado