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(HealthNewsDigest.com) – DALLAS, Dec. 17, 2012 — New streamlined guidelines will help healthcare providers better treat patients with the most severe type of heart attacks, according to an American Heart
Association/American College of Cardiology statement.
The guidelines are published online in the American Heart Association
journal Circulation and the Journal of the American College of
Cardiology.
The new recommendations are for a type of heart attack known as
ST-elevation myocardial infarction (STEMI), which occurs when a
cholesterol plaque ruptures and a blood clot forms within an artery
leading to the heart muscle, completely obstructing the flow of blood.
A potentially large area of the heart may be affected by the resultant
injury.
“Time is of the essence in the evaluation and treatment of these
patients,” said Patrick O’Gara, chair of the guidelines writing
committee. “The sooner blood flow is restored, the better the chances
for survival with intact heart function.”
The most feared STEMI complications are the emergence of a lethal
arrhythmia — a heart rhythm abnormality which can lead to cardiac
arrest — and heart failure as a result of the loss of a large amount
of heart muscle. About 250,000 Americans suffer an ST-elevation MI each year.
The guidelines focus on clinical decision-making at all stages,
beginning with the onset of symptoms at home or work, regional systems
of care to ensure that patients get immediate treatment, and the rapid
restoration of flow down the obstructed coronary artery.
Percutaneous coronary intervention (PCI), which comprises balloon
angioplasty to open a clogged artery and stents to keep it open, is the
preferred treatment strategy when it can be done quickly. When there
are delays, as may occur when a patient arrives at a facility where
intervention is not available, clot-busting drugs should be
administered if safe for the individual patient, followed by transfer
to a facility where intervention can subsequently be performed if
needed.
Other key points in the new guidelines include:
— Improving patient recognition of heart attack symptoms and the
importance of immediately calling 911. Patient delay in reporting
symptoms is one of the greatest obstacles to timely and successful care.
Travel by private car to the hospital is strongly discouraged.
— Recommending that emergency medical technicians perform
electrocardiograms in the field to facilitate more rapid triage and
speedier treatment.
— Using hypothermia (cooling) to treat patients who suffer cardiac arrest.
To reduce brain injury in these patients, cooling protocols should be
activated before or at the same time of cardiac catheterization.
— Providing care plans when the patient is discharged after STEMI, which
are clearly communicated and shared with patients, families, and other
healthcare providers. Referral for cardiac rehabilitation is a key
factor. A table in the guidelines itemizes these considerations,
including smoking cessation, cholesterol management, social needs,
depression, and cultural and gender-related factors that may contribute
to outcomes.
“We’re looking to a future where more patients survive with less heart
damage and function well for years thereafter,” said O’Gara, who is
also the executive medical director of the Shapiro Cardiovascular
Center and director of clinical cardiology at Brigham and Women’s
Hospital in Boston, Mass. “We hope the guidelines will clarify best
practices for healthcare providers across the continuum of care of
STEMI patients.”
The guidelines were developed in collaboration with the American
College of Emergency Physicians and the Society for Cardiovascular
Angiography and Interventions.
More information on quick treatment for STEMI is on our Mission
Lifeline website, where you can also find a map to locate STEMI systems
of care.
Co-authors are: Frederick G. Kushner, M.D.; Deborah D. Ascheim, M.D.;
Donald E. Casey Jr., M.D., M.P.H., M.B.A.; Mina K. Chung, M.D.; James
A. de Lemos, M.D.; Steven M. Ettinger, M.D.; James C. Fang, M.D.;
Francis M. Fesmire, M.D.; Barry A. Franklin, Ph.D.; Christopher B.
Granger, M.D.; Harlan M. Krumholz, M.D., S.M.; Jane A. Linderbaum,
M.S., C.N.P.; David A. Morrow, M.D., M.P.H.; L. Kristin Newby, M.D.,
M.H.S.; Joseph P. Ornato, M.D.; Narith Ou, Pharm.D.; Martha J. Radford,
M.D.; Jacqueline E. Tamis-Holland, M.D.; Carl L. Tommaso, M.D.; Cynthia
M. Tracy, M.D.; Y. Joseph Woo, M.D.; and David X. Zhao, M.D. Author
disclosures are on the manuscript.
For the latest heart and stroke news, follow us on Twitter: @HeartNews.
The American Heart Association/American Stroke Association receives
funding mostly from individuals. Foundations and corporations donate as
well, and fund specific programs and events. Strict policies are
enforced to prevent these relationships from influencing the
association’s science content. Financial information for the American
Heart Association, including a list of contributions from
pharmaceutical companies and device manufacturers, is available at
www.heart.org/corporatefunding
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