Considerations for a national heart attack alert program
C Lenfant1, J H LaRosa, M J Horan
1National Heart, Lung, and Blood Institute, Bethesda, MD 20892.
Insights
Rapid identification and treatment of acute myocardial infarction (AMI) are crucial for saving lives and heart tissue. Prompt medical care minimizes death and reduces coronary heart disease (CHD) morbidity and mortality.
Area of Science:
- Cardiology
- Public Health
Background:
- Coronary heart disease (CHD) is the leading cause of death in the U.S.
- Acute myocardial infarction (AMI) accounts for a significant portion of CHD deaths and costs.
- Primary prevention is important, but timely intervention after symptom onset is critical for survivors.
Purpose of the Study:
- To emphasize the importance of minimizing time from symptom onset to treatment for acute myocardial infarction (AMI).
- To explore opportunities for prompt intervention during evolving AMI to prevent sudden death and preserve cardiac muscle.
- To consider the establishment of a national educational program to reduce CHD morbidity and mortality through rapid AMI identification and treatment.
Main Methods:
- Review of CHD and AMI statistics and costs.
- Analysis of treatment goals for AMI (preventing death, salvaging heart tissue).
- Identification of critical time points for intervention during AMI.
Main Results:
- Delayed medical care reduces the effectiveness of lifesaving technologies for AMI.
- Prompt treatment is essential to salvage cardiac muscle and reduce long-term CHD impact.
- Significant challenges exist in achieving rapid identification and treatment of AMI.
Conclusions:
- Minimizing time to treatment is paramount for improving outcomes in acute myocardial infarction (AMI).
- National educational programs may be beneficial for reducing CHD mortality through faster AMI response.
- Further study is needed to address barriers to prompt and effective AMI care.
Abstract:
Coronary heart disease (CHD) remains the leading cause of death in the United States--in women as well as men. In 1987, CHD was responsible for 512,138 deaths, of which 253,542 deaths were attributed to acute myocardial infarction (AMI) and accounted for over $43 billion in direct and indirect costs. The disease spares no one. Primary prevention is clearly important, but for those in whom primary prevention has not been applied or has failed, acting to minimize the effect of a heart attack is of paramount importance. Many of its victims do not obtain appropriate medical care, or obtain it too late for the latest lifesaving technologies to be effective. The goal of treatment is to prevent death and to salvage as much heart tissue as possible. To achieve this goal, it is essential to minimize the time from the first symptoms and signs to treatment. Opportunities exist at each phase of an evolving AMI to intervene promptly and appropriately to prevent sudden death and to preserve cardiac muscle and thereby reduce CHD morbidity and mortality. Yet, formidable problems also exist. These and other issues are presently being studied by the National Heart, Lung, and Blood Institute staff and advisors in consideration of whether to establish a national educational program aimed at reducing CHD morbidity and mortality through the rapid identification and treatment of those with AMI.
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