Pre-hospital organization: The first links in the chain of survival for heart attack patients

September 1, 2009,

Mortality rate following a heart attack has fallen by more than 50% in Europe over the past 25 years. However, because only minor advances in the medical treatment of AMI are expected over the next decade, it is through organisational changes in the pre-hospital phase that mortality rate will continue this decline to below 5%.

We estimate that acute coronary syndromes (ACS) account for 1.5 million hospital admissions throughout Europe each year. Almost half these patients present with ST-elevation myocardial infarction (STEMI), which are major and immediately life-threatening events.

Just 30 years ago, mortality of acute (AMI, ) in Europe was over 30%. This rate has now dropped dramatically to around 10% within the first month. In clinical trials - where the sickest patients are often excluded - mortality rate is as low as 5%.

This dramatic improvement was initially brought about by the opening of dedicated coronary care units in hospitals. This was followed by 20 years of drug development, and a significant improvement in survival rates. Among the important drugs introduced were those preventing blood from clotting, or even dissolving the clot responsible for blocking the coronary vessel (and so causing the AMI. Other drugs groups include beta-blockers, ACE inhibitors, and statins develeoped to lower levels. More recently, the treatment of large heart attacks with balloon angioplasty has been a major advance. Although new and better drugs are being developed and drug combinations being refined, there is less belief in major drug breakthroughs in the next decade.

The pre-hospital phase of AMI treatment has also undergone several changes over the past decade: diagnosis, supported by telemedicine, has improved, and many interventions have been moved from the hospital to the field. It is in this early phase that we must now adopt new collaborations and organisations if mortality rate in this large patient population is to continue its decline. We must adopt new lean principles in the entire organisation of the pre-hospital phase, starting with public awareness of symptoms, and how to raise the alarm. For those patients whose first symptom is cardiac arrest, basic bystander resuscitation should become standard. Despite an abundance of automated external defibrillators (AED) in many regions, their localisation and use are often not well organised. Heart attack victims should call an emergency number, instead of being self or family-transported to the hospital.

There are financial and political disincentives for the transfer of STEMI patients for balloon angioplasty: all of these factors should be addressed:

Primary Hospital

  • Loss of revenues
Referring doctors
  • Loss of patients and subsequent revenue
  • Pride and unwillingness to admit that another physician can provide better medical care
  • Medico-legal liability during transfer
Lack of organised emergency services
  • Private company vs. fire department
  • Conflict between firemen and paramedics
  • Time constraints: prolonged run times, ECG triage
  • What incentive (transfer between hospitals is low paid in some countries)?
The mortality rate following heart attack is today historically low. Further reduction is unlikely to result from new drugs, but there is huge potential in the a leaner organisation of the entire pre-hospital phase. The successful full implementation of these measures has the potential to provide more than 75% reperfusion rate and could reduce mortality to below 5% and approaching the life expectancy rate of the age-matched general population.

Source: European Society of Cardiology (news : web)

Related Stories

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.