A good deal of coordination was needed to set up the system, he said. Ottawa, a city of 800,000, has four major hospitals, and all agreed to have heart attacks handled by the Heart Institute, rather than sending patients to the nearest hospital. Paramedics had to be trained to do electrocardiograms in the field, which was done in collaboration with the four hospitals, and the special telephone lines had to be established, the report said.
The program also includes treatment "in all aspects of cardiology," such as advice on diet and exercise, as well as smoking cessation when necessary, Le May said. Drug therapy for risk factors such as high cholesterol levels and blood pressure is started in the hospital and continued at home.
Careful planning would be needed to start a similar system in a larger city, Le May said.
"In a city with multiple catheter labs, you would have to get cardiologists together to work out a way for patients to be directed to catheter labs," he said. "You would have to sit down and develop specific pathways -- this hospital on this day, that hospital on that day."
And while Ottawa's improvement in survival may not be definitive, "we know from larger studies that there is a good correlation between lower door-to-balloon time and lower mortality," Le May said.
Dr. Alice Jacobs, professor of medicine at Boston University and a spokeswoman for the American Heart Association, said the Ottawa system fits right in with the heart association's program to improve care for STEMI patients.
"The American Heart Association understands that there is not a 'one-size-fits-all' solution," Jacobs said. Local affiliates of the association "are being convened into task forces that are identifying ways to establish national recommendations for STEMI systems on a local level in view of geography, resources and existing legislation and regulati
All rights reserved