Source: https://indianexpress.com/article/health-wellness
A study conducted by
the Institute of Cardiology at Madras Medical College connected 188 smaller
hospitals, which do not have catheter labs for angioplasty procedures, to 18
big hospitals in Tamil Nadu as part of a “hub and spoke” therapy model.
What if a person
suffers a heart attack in a remote village and the local health centre doesn’t
have a cardiologist or the infrastructure to do an angioplasty — a procedure to
remove blood clots from heart arteries? The patient can still live and recover
if the centre is connected to a bigger hospital through a chat platform, where
specialists can recommend clot-dissolving drugs to local healthcare personnel
and buy some time for the patient to get to a bigger hospital for surgical
interventions.
A study conducted by
the Institute of Cardiology at Madras Medical College connected 188 smaller
hospitals, which do not have catheter labs for angioplasty procedures, to 18
big hospitals in Tamil Nadu as part of a “hub and
spoke” therapy model. Cardiologists at bigger hospitals read the ECG, patient
history and test results, suggested drugs and procedures, all through WhatsApp,
improving the odds of patients at smaller centres surviving a heart attack.
What a pilot study
shows
The study, which
covered 71,000 people over five years, was able to demonstrate that just by
providing guidance to the smaller hospitals on WhatsApp, more lives could be
saved. Within five years, nearly one in five patients treated for heart attack
in the hub hospital came from a spoke hospital, indicating how the linking
system improved access. In the second phase of the study done with six hub
hospitals, the doctors saw a remarkable increase in the proportion of people
who got any intervention from 52.6 per cent in 2019 to 87.1 per cent by 2022.
The findings, which
were recently published in the Indian Journal of Medical Research, are
significant because they lay the template for broad-basing cardiac care to
cover the last mile. With more Indians experiencing heart attacks in their
early years, such a public health intervention can make heart care accessible
even during emergencies. The data is from the cardiac care policy implemented
by the government of Tamil Nadu.
Why this model can
reduce deaths from heart attacks
“The sooner a person
can undergo a procedure to open up a heart blockage or at least get a medicine
that can help in dissolving the clot, the more muscles we end up saving. Sadly,
a very small proportion of people receive these timely interventions,” said Dr
G Justin Paul, professor at the Madras Medical College who designed the model.
He also leads the state government’s heart attack management programme team.
“There are two types of
heart attacks. A STEMI (ST-elevation Myocardial Infarction) is a major heart
attack where the clot blocks blood flow completely to a part of the heart,
resulting in muscles dying. Non-STEMI is referred to as a minor heart attack.
Once the heart muscles die, there is no way of reviving them. However, there is
now enough evidence to show that giving the clot-dissolving drug immediately
and then doing the procedure within 24 hours is also equally effective. While
most hospitals may not be able to do the procedure, they can certainly give the
drug and then move the patients to the bigger hub hospital,” said Dr Paul.
In fact, the WhatsApp
chat platform also helps the smaller centres share transfer protocols and
coordinate patient care with the bigger hospitals. “This system of care worked
in Tamil Nadu because of the availability of cardiologists in several
Government hospitals, even in those that did not have a catheter lab prior to
the study. This may not be true for all of India. However, the model may be
modified and adopted,” said Dr Paul.
Benefits in numbers
In the first cluster
with 12 hub hospitals, including the key Madras Medical College, the proportion
of patients undergoing the stenting procedure after getting the clot dissolving
medicine streptokinase increased from 9.1 per cent to 33.2 per cent. The
proportion of patients able to receive the procedure within hours of heart
attack also increased from 5.7 per cent to 9.7 per cent.
“The cost of
angioplasty in a private hospital — which can range from Rs 1.5 lakh to Rs 6
lakh — can be a deterrent. But, more importantly, not all hospitals have the
facility to conduct the procedure. This is the reason many may not be able to
get the procedure within a few hours of the heart attack,” reasoned Dr Paul.
The results from the
second cluster were even more impressive. While the proportion of patients
undergoing the procedure immediately remained the same, those getting the procedure
after having received the medicine increased from 0.9 per cent to 5.3 per cent.
The proportion of deaths also reduced from 8.5 per cent to 5.8 per cent.
While the study used
the less costly streptokinase that is given as an infusion, newer drugs can
also be used. “These one-shot injections are costly at present, but the price
may be brought down by governmental action, much in the same way as the stent
prices were lowered,” said Dr Paul.
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