Heart care trial sees 20 pc reduction in deaths

A trial programme on heart attack care run in three districts of Tamil Nadu was able to reduce deaths by nearly 20 per cent over its year-long duration, according to a research paper.
Spurred by the "success" of this programme, Indian Council of Medical Research (ICMR) during a meeting recommended that this model be adopted across the country.
Officials of Ministry of Health and Family Welfare and representatives from 18 states participated in the meeting of medical experts and other stakeholders in January.
The pilot was conducted by not-for-profit STEMI India and supported by ICMR and Tamil Nadu government. It's findings have also been published in the latest issue of Journal of the American Medical Association (JAMA).

The trial was conducted in three districts of Tamil Nadu with a total population of 2.5 million people over a period of 47 weeks. 2,420 heart patients were enrolled between August, 2012 to June, 2013.
The study claims that it was able to "reduce patient death rates by 19 per cent."

The STEMI model has a hub hospital with a cath lab, which is linked to peripheral hospitals from where patients can be transferred.
The model relies on three critical elements. The unique STEMI Kit enables transmission of ECGs from a peripheral hospital to the hub hospital with an on-call cardiologist. This helps in early diagnosis of a heart attack.

The second important requirement for this model is an ambulance service for picking up a patient from his or her residence and for transferring from one hospital to another.
The third crucial element is BPL insurance to ensure that every patient can access this programme.
Through this pilot greater number of patients were administered superior therapies (primary PCI and pharmaco-invasive therapy) as compared to stand-alone thrombolysis. "The total percentage of these therapies went up from 35 per cent to 61 per cent," as per the study.
The peripheral hospitals saw this rate improve from an abysmal "3.5 per cent to 61 per cent."

"The drop in mortality rate was primarily because of access to superior treatment strategies made available to patients at peripheral hospitals," said Dr Thomas Alexander.
Therefore, "according to our cost-benefit analysis, for every rupee spent on this programme, the government will be able to save Rs 3.58," says Dr Alexander.
"In the three districts where we executed the pilot we were able to save 1,542 life-years and Rs 6.2 crore per year," he added.
For each network of hub and peripheral hospitals, the estimated expenditure is Rs 1 crore for implementing the STEMI model.
According to the Management of Acute Coronary Events Registry, instituted in 2014, the median time recorded for 5,300 patients from 12-13 states between chest pain and transfer of patient to hospital is 400 minutes. Experts say this should ideally be at 60 minutes.