Stopping A Killer: LUMEN 2009 Looks To Establish National Protocol For Treating Heart Attack Patients

Main Category: Cardiovascular / Cardiology
Also Included In: Heart Disease
Article Date: 26 Aug 2008 - 1:00 PDT

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It is the very early hours of the morning and you awake with a tightness in your chest. This uncomfortable pressure is making it difficult to breathe, and you feel lightheaded and nauseous. Your first instinct is to shrug off the fear that you might be having a heart attack and attribute your pain to heartburn from overindulging the night before or even food poisoning. Yet if you continue to avoid taking your pain and symptoms seriously, your life is at risk - and the clock is ticking.

According to the American College of Cardiology (ACC), the majority of deaths from STEMI (ST elevation myocardial infarction), a heart attack caused by complete obstruction of a coronary artery, occurs within the first 1 to 2 hours after symptom onset. And, although heart disease is the leading cause of death in the United States, there is still no protocol in place for an integrated STEMI system and national STEMI policy.

LUMEN 2009: The Symposium on Optimal Treatments for Acute MI launches February 26-28, 2009 in Miami Beach to address the need for establishing protocols nationwide for the appropriate care of acute heart attack patients.

In the scenario above, time is of the essence. Call 9-1-1. Do not drive or have someone drive you. Transportation by EMS is a better option than self-transport because you can be immediately evaluated and have treatment initiated by paramedics prior to arriving at the hospital. The appropriate staff can be called in while you are still in transport.

But even as skilled staff is en route to the hospital and EMS is working to save your life, in most American communities, you are not going to receive the critical care you need. For patients experiencing a heart attack, where time is absolutely critical, there is no established national protocol to treat STEMI patients, one that would ensure patients are routed to a STEMI-certified hospital equipped to not only save the life of the patient, but to make sure minimal damage is done to the heart muscle. Instead, EMS has only one guideline set out by local municipalities - transport the critical care heart attack patient to the closest hospital, often a facility that lacks the equipment and expertise to save the heart attack victim.

STEMI expert Dr. Sameer Mehta and many of his colleagues argue that the U.S. is well behind some of its international counterparts in establishing STEMI protocols to effectively treat these patients in ways that parallel our current national trauma system.

"Level one trauma centers are set up for catastrophic events like car accidents with emergency medical personnel assessing the immediate need of a patient at the scene and then transporting that patient to the closest trauma center equipped to handle that patient's needs, not the closest hospital. Such patients are also often transported by helicopter to ensure quick, immediate access to quality care," says Dr. Mehta, Lumen 2009 Program Director and author of the Textbook of STEMI Interventions.

A national initiative to establish STEMI Receiving Centers within hospitals is the backbone of LUMEN 2009: The Symposium on Optimal Treatments for Acute MI. In various European countries, such as Denmark, integrated centers for STEMI care have been operational for several years. In Ottawa, Canada, a program exists under which 800,000 residents of the city have been triaged to receive angioplasty for the occluded artery.

In limited areas of the United States, some integrated systems of triage and transfer for STEMI patients have been created by local emergency service operations. These include the Mayo Clinic, Minneapolis Heart Institute, SOCAL system in Southern California and RACE system in North Carolina. Yet the majority of Americans, even those in large, metropolitan cities, will not be treated successfully for their STEMI. LUMEN 2009 brings together international leaders to discuss needed protocols vital to establishing a national system to combat the number one killer of men and women in the U.S.

"Time = heart muscle," adds Dr. Mehta, who advocates angioplasty for STEMI patients instead of thrombolytic therapy (drugs), whenever possible. "The longer the time to treatment, the greater the amount of heart muscle affected by deprivation of oxygenated blood and the likelihood that the patient will die or be unable to fully recover."

The time from the patient's arrival at the hospital to the opening of their blocked artery, often referred to as door-to-balloon (D2B) time, should be no more than 90 minutes, as recommended by the American College of Cardiology/American Heart Associations (ACC/AHA) Clinical Guidelines for STEMI care; any longer than 90 minutes can mean irreversible damage to the heart muscle. Of the 500,000 reported STEMI patients in the U.S. annually, only half find themselves in hospitals capable of performing immediate angioplasty. Although thrombolytics offer relief of symptoms and have the advantage of being administered early and even in the ambulance, a very high proportion of patients do not achieve complete clearing of the blockage and a majority end up also needing angioplasty. The long-term recovery of the heart muscle is better with angioplasty and the risk of stroke is less.

"Establishing a national protocol is vital, and possible. STEMI treatment is not just the domain of the interventional cardiologist; it is a matter of public health policy," says Dr. Mehta.

LUMEN 2009, the world's premier STEMI meeting, is expected to draw international experts discussing issues related to STEMI interventions, and key areas of interventional cardiology and vascular interventions. Dr. Sameer Mehta serves as the Director of LUMEN 2009. The four Co-Directors for the CME program include world experts Dr. Samin Sharma (Complex Coronary Interventions), Dr. Brahmajee Nallamothu (D2B Processes), Dr. William Hoekstra (Emergency Medicine Pathways for STEMI) and Barbara Unger, RN (STEMI Systems & Cardiovascular Nursing). The innovative CME agenda will include lectures, debates, workshops, certification courses and industry satellite programs. The meeting will be held February 26-28, 2009 at the Loews Miami Beach Hotel in Miami Beach, Florida. According to a Centers for Disease Control (CDC) study, "Prevalence of Heart Disease - United States," Florida residents rank in the top 10 for high prevalence of heart disease.

LUMEN 2009 will become the one-stop, STEMI educational rendezvous for Clinical and Interventional Cardiologists, Cardiac and Vascular Surgeons, Emergency Department staff, Critical Care Nurses, Cardiovascular Laboratory Technicians and Nurses, Paramedics, and Hospital Administrators who are all invested in optimal outcomes for heart attack patients. To learn more, visit http://www.LUMENami.com.

LUMEN 2009 is sponsored by the North American Center for Continuing Medical Education (NACCME), a wholly-owned subsidiary of HMP Communications Holdings, LLC. NACCME provides a wide array of accredited CME offerings, with industry thought leaders participating in round table meetings, webcasts, symposia, conferences, seminars, podcasts, and satellite programs.

http://www.LUMENami.com