New heart disease treatment protocol improves angiography; lowers mortality

An Indo-US team of medical specialists has perfected a new heart disease treatment protocol that has the potential to save lives of thousands of Indians requiring timely medical care following a heart attack. 

The hub-and-spoke model – tested successfully in Tamil Nadu – involves quick transfer of a patient in an ambulance to a small health centre for medication before transferring the person to a larger hospital for angiography and angioplasty if required.

Trained paramedics performed ECG of the patient inside the ambulance and transmit the image to specialists in hub hospitals where cardiologists screen the ECG and guide ambulances to the nearby spoke centres.

At the smaller spoke clinic, patients receive clot-busting drugs before they are shifted to the nearest big hospitals for angiography and angioplasty.

This led to a nearly 10-fold increase (3.7% to 33.5%) in the proportion of patients transferred from smaller spoke centres to larger hub hospitals, higher rates of coronary angiography (from 35% to 60%) and higher rates of primary angioplasty (46% to 70%).

Conducted between 2012 and 2013, the study was carried out over 32 weeks on 2,420 patients who were given treatments at 35 spoke centres and four large hospitals that served as the hub.

It compared these 2,420 patients with those of standard treatment received by 898 patients for a period of 12 weeks.

After one year, they found 3% lower mortality among those, who were treated as per the TN-STEMI protocol.

However, what is possible in Tamil Nadu and Kerala is not representative of all states as these states are at the higher end of the spectrum in terms of health, said Banerjee, who is not involved in the study.

“Tamil Nadu ST Elevation Myocardial Infarction Program (TN-STEMI) is an unique heart attack management programme, which has shown that it was possible to reduce heart attack mortality significantly,” an official from TN-STEMI programme told DH.

Several doctors from Tamil Nadu and medical researchers from the University of Michigan were involved in the study that were partly funded by the Indian Council of Medical Research and had the active participation of the Tamil Nadu government. 

The scheme was also linked to the BPL insurance program to ensure that the poor could also access this care.