Karnataka cardiologists to extend angioplasty scheme to remote areas

ECG on patient in ambulance before shifting to hospital

Cardiologists from Karnataka are set to launch a major programme to expand the coverage of angioplasty in far-flung areas. Doctors from Sri Jayadeva Institute of Cardiology, Narayana Hrudalaya and many smaller hospitals would be associated with the scheme that is likely to be rolled out first in Kalaburagi by the middle of this year.

 “We will have to equip 10-15 taluk hospitals and train the doctors, which may take some time. We hope to start the programme around June-July,” cardiologist and director of Jayadeva Hospital C M Manjunath told DH.

The programme would be based on a hub-and-spoke model that involves quick transfer of a patient in an ambulance to a small health centre before transferring him/her to a bigger hospital. Trained paramedics would perform an ECG inside the ambulance and transmit the image to specialists in hub hospitals where cardiologists would screen it and guide the van to nearby spoke centres for clot-busting medication before the patient is taken to the hub hospital for angiography and angioplasty, if needed. Subsequently, three more programmes would begin in areas surrounding Bengaluru, Mysuru and Mangaluru, each catering to a population of about 25 lakh.

The model was successfully tested in Tamil Nadu and received support from the Indian Council of Medical Research (ICMR). “We are expanding our model in Karnataka, Andhra Pradesh, Telangana and Meghalaya. In Karnataka, 12 cath labs will be associated with the programme, including Jayadeva Hospital and Narayan Hrudalaya,” said Director of Cardiology at the Madras Medical Mission Ajit Mullasari.

“Currently, the average symptoms-to-door (hospital) time in the country is about 400 minutes whereas ideally, the patient should be hospitalised within half-an-hour and arterial procedure be done within two hours. Such programmes would help bridge the time gap,” said ICMR official S Meenakshi. The Tamil Nadu ST Elevation Myocardial Infarction Programme (TN-STEMI) is a unique heart attack management programme that demonstrated how it was possible to reduce mortality rate due to heart attacks significantly by involving a large number of hospitals and ambulances in the network.

The Tamil Nadu programme led to a nearly 10-fold increase (3.7% to 33.5%) in the proportion of patients transferred from smaller centres to bigger hospitals, higher rates of coronary angiography (from 35% to 60%) and higher rates of primary angioplasty (46% to 70%). More than 48% patients belonged from poor socio-economic background.

“Each cluster needs about Rs 1.5 crore and at least 12 ambulances for the programme,” said Thomas Alexander, a cardiologist at Kovai Medical Centre and Hospital in Coimbatore, which too is involved with the Tamil Nadu project.
DH News Service