Covid-19 delays state government project aimed at management of heart attacks

The Covid-19 pandemic has delayed a project proposed by the State National Health Mission (NHM) more than five months ago that could have led to the efficient management of acute heart attacks at the taluk level.

First proposed in September 2020 at a cost of Rs 2.3 crore, a hub and spoke model was meant for efficient patient management at the taluk level of those who suffer from STEMI (ST Elevated Myocardial Infarction) which is a severe heart attack. In this, one of the heart's major arteries (one of the arteries that supply oxygen and nutrient-rich blood to the heart muscle) is blocked.

Five months on, the state is still in the process of placing newspaper ads calling for agencies to monitor this system, and the hub and spoke model is still not off the ground.

The reason being Covid-19, Sri Jayadeva Institute of Cardiovascular Sciences and Research Director Dr C N Manjunath said. This was echoed by the State's deputy director for non-communicable diseases, Dr Rangaswamy H V. He told DH, "Due to coronavirus, we could not proceed with the project. We have placed newspaper advertisements inviting 'expression of interest' only now."

The idea is to have three branches of Jayadeva act as the hub hospitals, in Bengaluru, Mysuru and Kalaburagi.

The government is looking for NGOs and firms that will link these three hospitals to 45 spoke hospitals or taluk hospitals via 45 ambulances equipped with STEMI kits that has an ECG machine, defibrillator, pulse oximeter, and a mobile phone.

This is important as for every half an hour delay in treatment of heart attack, there is a loss of 50% heart muscle and the risk of death increases by 7%. In Karnataka, it is estimated that 96,150 are affected by STEMI every year. They need to be treated within 90 minutes of the attack. Under this project, every case will be tracked and recorded for up to four years after treatment.

"The outcome of 4,000 patients who suffered a heart attack in the last year alone who were treated with clot-dissolving medicine or angioplasty showed a mortality of 2.75%. When untreated, it is 14%. The treatment is time-dependent. If it is initiated within the first three to six hours of the onset of heart attack, the survival is more and the outcome is also better," Dr Manjunath said.

In hospitals at the periphery and taluk hospitals, facilities for treating a heart attack is not available.

Some taluk-level physicians are capable of treating heart attacks and others are not. Patients are required to long distances to reach a tertiary care centre. To facilitate heart attack management in taluk hospitals, this project has been conceptualised. Funded by NHM, Jayadeva is the implementing tertiary heart hospital.

"In each revenue division of Bengaluru, Mysuru and Kalaburagi, 15 taluk hospitals have been mapped to Jayadeva, in all, 45. Here physicians will be trained to medically manage heart attacks. Each cluster will have a State coordinator and there will be six hub coordinators too.

The moment an ECG is taken at any of these 45 taluk hospitals, it will be transmitted to cardiologists in one of the three Jayadeva hub hospitals. Once the diagnosis is confirmed clot-dissolving medicine is given and then shifted to nearest Jayadeva hospital in these zones," Dr Manjunath said.

Once the clot-dissolving medicine is given, that buys the patient 24 hours time for primary angioplasty. Tamil Nadu STEMI Project for example has been successful.