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Cardiologist Champions Care for Heart Attack Patients

Smalling offers Houston perspective as national model for faster, better care

When it comes to care for heart attack patients, a system developed in part by physicians at The University of Texas Medical School at Houston and implemented at Memorial Hermann-Texas Medical Center could serve as a national model.

In a “Physician Perspective” published July 10 in the print edition of Circulation, a journal of the American Heart Association, seven physicians weighed in on ideal systems of care for ST-segment-elevation myocardial infarction (STEMI). Richard Smalling, M.D., Ph.D., professor in the Division of Cardiology at UT Medical School at Houston, served as co-chair of the writing panel.

“We are championing definitive care that is faster and improves outcomes for heart attack patients,” said Smalling, director of interventional cardiovascular medicine at Memorial Hermann-TMC. “We’re already doing this here and it works.”

According to the “Physician Perspective,” an effective STEMI care system relies on a team of multiple physicians, nurses, emergency medical services personnel and other providers to work in an efficient, collaborative manner to deliver optimal patient care.

In order to do this, physicians must be committed to providing timely care for patients with acute myocardial infarction. They must obtain full cooperation from hospital and medical staff at local, referral and regional levels; implement innovative team-based methods for overcoming barriers to ideal STEMI treatment; and use credible clinical information systems for prompt data collection and feedback.

Nearly 400,000 a Year

STEMI, or acute myocardial infarction, is a type of severe heart attack caused by a prolonged period of blocked blood supply. It affects a large area of the heart muscle. According to the American Heart Association, nearly 400,000 patients suffer this type of heart attack every year and can benefit greatly by having potential heart damage reduced if their blocked artery is opened in time.

Primary care and specialist physicians must work together in integrative net-works, the writing team recommends.

The ideal STEMI care system begins with community education. Physicians should promote early recognition of heart attack and the need to call 9-1-1 quickly at the onset of chest discomfort. Paramedics and emergency physicians should be trained to accurately interpret electrocardiogram readings and promptly initiate appropriate care.

In an ideal system, patients would be transferred by ambulance to a hospital that has interventional cardiologists and staff who can respond within 20-30 minutes to reopen blocked arteries.

Obstacles to Overcome

There are obstacles, the “Physician Perspective” acknowledges. Physicians in rural areas may not have timely educational materials on STEMI care issues.

The writing group recommends Internet-based materials and written protocols that address practice variations in real-world practices.

There are also obstacles to overcome with transfer policies, finances and physicians’ time. The publication states that hospitals and physicians may be reluctant to transfer heart attack patients to a competing institution, even if the competing hospital is better equipped to quickly meet the medical needs of the patient.

Smalling, the Jay Brent Sterling Professor in Cardiovascular Medicine at the UT Medical School, stressed that funding is a major challenge in creating the optimal system of care for heart attack patients. Funds are needed to conduct research that establishes the best protocols of care and then to implement those systems at hospitals in Houston and around the country.

Smalling said he hopes the “Physician Perspective” will serve as a catalyst for change. Already, recommendations listed in the publication are being carried out at Memorial Hermann-TMC. For years, physicians at the UT Medical School have worked with the hospital and the Houston Fire Department Emergency Medical Services to diagnose heart attacks and begin treatment before patients even arrive at the hospital.

By Meredith Raine, Institutional Advancement

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