This year an estimated 1.4 million people will suffer a heart attack. Approximately 400,000 of those victims will experience a ST-elevation myocardial infarction (STEMI).
The Primary Cause of Heart Attack
A heart attack occurs when the blood flow to part of the heart muscle is limited, severely reduced or stopped because one or more of the coronary arteries supplying blood is blocked. When this takes place, oxygen cannot get to the affected area of the heart. If the blood supply is cut off for more than a few minutes, the affected portion of the heart suffers permanent injury and may die. This can kill or disable someone, depending on how much heart muscle is damaged.
How do the arteries get blocked in the first place? Arteries become blocked gradually over time when fat, cholesterol, and other substances referred to as “plaque” build up on their walls. When plaque in an artery breaks, a blood clot can form around the plaque, which shuts off blood flow. When damage or death of part of the heart muscle occurs as a result, it’s referred to as a heart attack. Medical terms for heart attack include coronary thrombosis, coronary occlusion, or myocardial infarction.
STEMI vs. Non-STEMI Heart Attacks
ST-elevation myocardial infarction, or a STEMI heart attack, happens as a result of a complete blockage in a coronary artery. A STEMI attack carries a great risk of death and disability. When an artery is partially blocked and severely reducing blood flow, a non-STEMI heart attack may occur.
The fastest way to diagnose whether a heart attack is a STEMI or non-STEMI is through a device called a 12-lead electrocardiogram (ECG). Mission: Lifeline advocates that every ambulance be equipped with this type of machine. By diagnosing a patient on the scene rather than waiting until they are transported to a hospital, emergency medical service (EMS) personnel can determine the best course of action to take to begin the appropriate means of treatment quickly.
Preferred Means of Treatment
There are two categories of treatment used to restore blood flow through an artery (formally known as “reperfusion”) following a heart attack:
- Clot-busting Medicines
Also referred to as clot-busting pharmaceuticals, fibrinolytics, thrombolytics, or lytics, this type of treatment is widely available at most hospitals. It can be quickly administered, but it is most effective if the patient is treated within 30 minutes of the attack. It does pose a bleeding risk. While there is widespread use of clot-busting medicines, it is not the preferred means to treat STEMI heart attack patients.
- Mechanical/Surgical Means
This type of treatment involves stents, angioplasty, or a similar method of opening the arteries using mechanical methods. The medical term for this type of treatment is percutaneous coronary intervention (PCI). PCI is the preferred means of treating STEMI patients, proving more effective than clot-busting medications. Plus, it poses less bleeding risk. PCI should be performed on a patient within 90 minutes.
Unfortunately, PCI is not readily available, particularly to Americans living in rural areas. Only about 39% of U.S. hospitals have the equipment, expertise, and facilities to deliver this type of treatment. These PCI-capable hospitals are called STEMI-receiving hospitals because they are well equipped to receive and treat STEMI patients.
Despite their inability to perform PCI, community hospitals that can administer clot-busting medicines can meet the health care needs of non-STEMI patients. However, non-PCI hospitals cannot meet the needs of STEMI patients as well as PCI-capable hospitals can. That’s why non-PCI hospitals are also called STEMI-referring hospitals – they refer STEMI patients to PCI centers.
In instances where a patient cannot access a PCI hospital within the golden 90-minute window, the best avenue of treatment might then be for the local hospital to administer clot-busting medicine. Unfortunately, approximately 30% of STEMI patients do not receive any form of treatment to restore blood flow, whether through clot-busting drugs commonly referred to as thrombolytics or percutaneous coronary intervention (PCI), the latter being the preferred therapy which uses mechanical means such as stents, balloon angioplasty, or surgery.
Time is Muscle
The outcome of STEMI events depends greatly on the care patients receive and the timeframe in which they receive it. The American Heart Association and the American College of Cardiology’s guidelines recommend that balloon angioplasty be performed within 90 minutes – preferably less – of arrival at any hospital.
In partnership with the medical community, this collaboration has the power to transform patient care for future heart attack victims in Iowa. This innovative regional collaboration works to ensure equipment compatibility, consistent training and uniform protocols for both transporting and treating heart attack patients across the region.
The Mission: Lifeline initiative in Iowa was launched in February, 2015 and has been implemented over three years in collaboration with Iowa’s health systems, emergency medical service (EMS) providers, the Iowa Department of Health and Human Services’ Division of Public Health, and others. Mission Lifeline helps identify the gaps that lead to slower and less effective patient care and, with the providers in the state, closes those gaps through change in protocols and processes, and also in providing resources such as life-saving equipment.
Iowa is fortunate to have a strong Mission: Lifeline Iowa State Task Force including representation from Dubuque that meets monthly providing insight and leadership. We have already seen measurable year-over-year improvement statewide.
The Leona M. and Harry B. Helmsley Charitable Trust is the lead funder of this initiative, providing a grant of $4.6 million to enhance systems of care, save lives, and improve outcomes for heart attack patients in rural Iowa. Other current funders include: Community Foundation of the Great River Bend, Principal Financial Group Foundation, and UnityPoint Health, in honor of its rural affiliates.
Mission: Lifeline Iowa has invested over $300,000 in the Dubuque Area providing grants for each of the Dubuque hospitals and several surrounding EMS services.
Editor’s note: This article was provided by the Mission: Lifeline Iowa initiative.