Cardiologist Champions Care for Heart Attack Patients,
Offers Houston Perspective as National Model
HOUSTON – (July 10, 2007) – 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.
Richard Smalling, M.D., Ph.D., holder of the Jay Brent Sterling Professorship in Cardiovascular Medicine at the UT Medical School at Houston.
In a “Physician Perspective” published today 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.
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 networks, 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 to within 20-30 minutes to reopen blocked arteries.
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, holder of the Jay Brent Sterling Professorship in Cardiovascular Medicine at the UT Medical School at Houston, 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.
In terms of physicians’ reimbursement, “an ideal system should appropriately align the goals and incentives for all stakeholders, including physicians, patients, hospital and payers,” the publication states.
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 at Houston 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.
Just last month, the U.S. Department of Health and Human Services measured how hospitals around the country perform when it comes to treating patients suffering from heart attacks or heart failure. Memorial Hermann-TMC received excellent marks, exceeding the national average for quality of care. For the results, visit http://www.hospitalcompare.hhs.gov.
Peggy Gray, director of Quality Improvement Initiatives of the American Heart Association’s Houston/Gulf Coast Division, said a system of optimal care for STEMI patients begins with interest from the physicians and the community.
“The physicians champion the best interests of the patients. If we have their commitment, we can start small and then try to tackle the whole country,” Gray said. “We are trying to ensure that patients who have a STEMI heart attack are treated in a timely manner and hospitals are equipped to handle it. The physicians and support from the community are critical to making that happen.”
The “Physician Perspective” is one of several papers published today in Circulation as a result of a national conference convened by the American Heart Association to address the need for developing regional STEMI systems of care across the country to improve outcomes for heart attack patients.
For a copy of the “Physician Perspective,” visit http://www.circulationaha.org.