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Life-Saving Procedure Reducing Heart Deaths

CHARLESTON, S.C. -- In the past year, Charleston Area Medical Center cardiologists, emergency physicians and Kanawha County Emergency Ambulance Authority paramedics have teamed up to reduce heart attack deaths in the county.

They've dramatically decreased the time between when someone suffers a specific type of heart attack - called a Segment-elevation myocardial infarction, or STEMI - and when their blocked artery is cleared and blood flow restored through a clot-busting drug or life-saving angioplasty at the hospital.

In early 2007, about 40 percent of STEMI patients were treated within 90 minutes after arriving at CAMC.

Now, 80 percent of patients are receiving treatment within the 90-minute window recommended by the American Heart Association, according to a recent analysis by Charleston cardiologist Dr. William Carter.

"It improves the outcomes if you get the vessel open sooner rather than later," said Carter, who's directing a project to expand the initiative to a nine-county area in central and Southern West Virginia.

A principle reason for the faster treatment: STEMI patients are being diagnosed before they arrive at the hospital.

Paramedics are using portable "12-lead" electrocardiograms, or EKGs. They take the EKG at heart attack victims' homes or while transporting them to the hospital.

They transmit the EKG results using a cell phone and Bluetooth wireless technology. An Emergency Department physician reads the EKG, confirms the STEMI and declares a "cardiac alert." Calls automatically go out to a cardiologist and heart-care support personnel, who rush to the hospital if they're off duty.

They're often there before the patient arrives.

"It's a great advance in hospital emergency care," said Dr. John Burdette, the Kanawha County ambulance authority's medical director and an Emergency Department physician at Saint Francis Hospital. "It's an extension of the ER into the field."

Added Tim O'Neal, a Saint Francis emergency room nurse: "When it works, it's beautiful."

Years ago, only 10 percent of STEMI diagnoses were made in the field - the rest done at the hospital.

Now, nearly all the diagnoses are being made remotely, provided cell phone service is available.

"Right now, Kanawha County is ahead of most of the rest of the country in the utilization of EKGs in the ambulance," Carter said.

Last month, CAMC received a $200,000 Claude Worthington Benedum Foundation grant to expand the STEMI project to central and Southern West Virginia.

The project will train doctors and paramedics, and enlist the support of hospital and EMS administrators.

"This can be done in rural areas," said Robin Rector, CAMC Institute's education director. "Our size almost makes things easier for us than in a large metropolitan area. It's one of those reverse types of positions."

However, in many rural counties, it's difficult to get a heart attack victim to a hospital cardiac-care lab within 90 minutes.

There's an alternative, Carter said. Patients could receive clot-busting drugs - administered by nurses under doctors' orders - at community health clinics.

"It might make more sense to drive to a clinic in Big Otter or Whitesville and have them give you a clot buster, then drive to the hospital cath lab an hour and a half later," Carter said.

Carter also recently had preliminary discussions with medical personnel at Pocahontas County's Snowshoe resort about the possibility of making clot-busting drugs available there. The resort was receptive to the proposal, Carter said.

Carter and others hope to expand their STEMI project statewide.

"We have achieved the goal in Kanawha County," Carter said. "We're now interested in explaining ways to do this in rural counties. We're trying to improve the outcomes of people with heart attacks."

Nationally, about 400,000 people a year suffer a STEMI.

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