Cath Lab Digest - February 2008 - (Page 36)

36 STEMI INTERVENTIONS FEBRUARY 2008 three components are critical — indeed, some countries may find one barrier more challenging than the others. In his visionary introduction to this textbook, Dr. King also cites logistics as the major barrier to success. The author strongly agrees with this assessment and refers readers to the outstanding work done by the Yale investigators in this area.1 A review of the superb Mayo Clinic STEMI program answers another important issue. The Mayo investiga- tors incorporated four of the six recommendations made by the Yale researchers.2 Indeed, this pattern is visible at various other integrated programs wherein investigators are cultivating their programs in response to their specific challenges. Some institutions are hesitating on the need for a cardiologist in-house and about the different methodologies of EMS alert of the emergency department, the cath lab and the cardiologist. The issue of paying for the care of the millions of indigent patients will also require careful address by community, state and federal agencies. As mentioned before in the SINCERE (Single INdividual Community Experience REgistry for Primary PCI) database chapter, about 23% of patients within the database had no insurance. Who pays for the burgeoning numbers of these patients presenting with STEMI? Is it fair for a cardiologist who is pro- viding this care, often at off-hours, to not be fairly compensated for the efforts that often border on being heroic? Often this care is provided in the midst of the very legally-challenging environment that exist in numerous emergency rooms. As hospitals develop STEMI programs and as policies are being developed, the care of indigent patients and of adequate physician compensation and liability protection will need to be addressed. …Some exciting information technology (IT) modalities are delivering on-line data to the physicians. The role of these and other IT enhancements will increase efficiencies of the delivery systems. GPS guidance may speed physician arrival and navigation with traffic in urban locations. Transportation of the interventional cardiologist will need improvements, and helicopter transport, police-escort and permission to use sirens are some suggested methods. Of course, in-house 24/7 availability of the interventional cardiologist (the author’s preferred strategy at one of 5 SINCERE sites over a period of two years) and of the team are the ultimate logistical solutions. More critical is the need to address patient-related issues that delay STEMI access. Two studies have been cited in the figure and they provide a pragmatic framework to develop patient education and awareness models. The role of press, other media, pharmaceuticals, and of organizations such as American Medical Association (AMA), American Heart Association (AHA) and American College of Cardiology (ACC) is critical in this function. Backward integration of the STEMI model to educate the patient in seeking early care is almost as critical as the creation of an effective STEMI triage pathway. Institutions providing STEMI care must offer patient education — specifically about the two critical elements of seeking early care and using EMS to reach the hospital. Five specific benefits from use of EMS should be advocated: 1. Prompt EKG diagnosis and EKG transmission; 2. Early pharmacologic management, including pre-hospital thrombolysis; 3. Management of complications; 4. Triage to STEMI institution; 5. Activation of ED and CVL teams at a primary PCI institution. The final barrier is one presented by legislative hurdles — it is the author’s

Table of Contents Feed for the Digital Edition of Cath Lab Digest - February 2008

Cath Lab Digest - February 2008 Bay Regional Medical Center ENDEAVOR IV: A Zotarolimus-Eluting Stent Versus a Paclitaxel-Eluting Stent in a Randomized Clinical Trial A 3D CT Vessel “Roadmap” Over Live Fluoroscopy for Chronic Total Occlusions Contents Clinical Editor’s Corner An Evaluation of Cath Lab Turnaround Time Commentary: An Evaluation of Cath Lab Turnaround Time Excerpts from Chapter 19. STEMI Interventions – Future Perspectives The Potential Clinical Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents The Ten-Minute Interview with…Debbie Charlton, RN The Society of Invasive Cardiovascular Professionals (SICP) at Transcatheter Cardiovascular Therapeutics (TCT) 2007 The Cath Lab is a Business: Do You Have the Knowledge to Stay Afloat? Incidence and Predictors of Vascular Complications after Invasive Coronary Procedures: A Prospective Analysis Ask the Clinical Instructor: A Q&A Column for those New to the Cath Lab Volunteer Survey SICP* Section Meetings Calendar What Do You Think? CEU Education Center Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - February 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.