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New heart attack plan of action

India’s national health policy will soon see a customised set of heart attack management steps added to its protocols. The project – titled ST-Segment Elevation Myocardial Infarction India (STEMI India) – was designed by the Indian Council of Medical Research (ICMR).  Cardiologists have implemented a trial run in Tamil Nadu. There are hopes it will next be introduced in other states, eventually becoming a national policy.

Heart attacks are a leading cause of death in India

ST-Segment Elevation Myocardial Infarction is the medical terminology for what is commonly known as a heart attack. A heart attack is caused by a portion of heart muscle dying off. This impairs the function of the heart and is often fatal if not immediately treated. The reason behind the death of heart muscle is typically due to obstructed blood flow within one of the coronary arteries providing blood to the heart muscle itself.

Obstructions account for the majority of heart attacks. However, the cause of the obstruction can vary. Commonly the clogging of the artery will be due to atherosclerosis, a condition in which fatty, calcified plaques are deposited within the artery over time. Blood clots can form in the tightened region of the artery where the plaques are present. This causes a sudden loss of blood flow to the region downstream of the clot, in this case causing the heart attack.

A primary cause of atherosclerosis is obesity. In recent years India has risen to third in the world in terms of the total number of obese people, behind the US and China. (However, a relatively low percentage of India’s overall population is obese). The rise in numbers has resulted in a rise in non-communicable diseases, including heart disease.

The trial run of STEMI India in Tamil Nadu was undertaken as part of a study published in the Journal of the American Medical Association (JAMA) cardiology section. The results of the trial indicate a significant reduction in mortality and major adverse cardiac events during the trial period, compared to before the study.

The implementation of the study does little to change actual medical techniques or the treatment of heart attacks. Instead, it reforms the structural organisation of the response. Most critical to the study was improving the access to primary percutaneous coronary intervention (PCI). Through improved health information technology, a number of smaller clinics and emergency response services were linked to centralised, PCI-capable hub hospitals. This allowed for improved communication between health services, leading to better access to facilities.

The success of this method is largely due to the nature of heart attacks, in which time is a critical factor and so increased access and more rapid response from adequately equipped healthcare providers will reduce  the mortality rate.

However, similar programmes providing greater access to healthcare and facilities will no doubt show improvements in other illnesses. The results of this study and the implementation at a national level may showcase this fact and its relevance to healthcare on a more broad level.


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