Together, improve management of myocardial infarction

Each year, about 100,000 people suffer from myocardial infarction in France. Although mortality has significantly decreased since 10 years, 13% of patients still die in the year following the accident. To improve support, health authorities have established a programme of priority actions.

The heart 2007-2010 program aims to further reduce mortality and complications of myocardial infarction by improving the different steps of its support. To do this, many recommendations for action and 30 good clinical practice indicators have been determined. Their development would help to assess the reality of the expected improvement.

acute chest pain

Evocative acute chest pain? Call the 15!
The phase known as acute myocardial infarction, the pain to the proper medical intervention, is a crucial step of the optimization of the support. Indeed, on the 13% of deaths in the first year, 7% are held during this initial stage! But only a quarter of the myocardial infarction have recommended optimal course: 15 (UAS) call and direct transfer in interventional cardiology.

To improve those numbers, the high authority for health (HAS) advocates improving professional practices (observatories, surveys, records of practices…), which will help “improve myocardial reperfusion rate up to more than 90 %”.

HAS also recommended to promote the initial management of patients by direct calling of the UAS (15) in the case of evocative pain. According to Dr. Patrick Goldstein, emergency physician, “people do call ever for a myocardial infarction, but for chest pain. Patients or their families have a single number to call, 15 ”. The Samu physician will ask then 2 or 3 simple questions on the telephone on pain (type, duration, irradiation to the jaw or arm…), and the slightest doubt, will send a team capable of performing an electrocardiogram (ECG). In the meantime SAMU, in the case of heart failure associated with this pain, should practice a cardiac massage to limit the consequences of myocardial infarction.

If a heart attack is diagnosed to the ECG, the unblocking of the arteries of the heart (reperfusion) is an emergency. It can be performed on-site with a drug that will dissolve the clot, Thrombolysis, or in interventional cardiology with the completion of an angioplasty. As Dr. Goldstein, “the goal is to provide to the patient as quickly as possible a reperfusion strategy”, which is not yet the case for the three quarters of the victims.

Calling systematic 15 by any person in case of a persistent acute chest pain, triggered the effort or the rest, with feeling of tightness, radiating to the jaw or arm, pallor, disorder potential witness of conscience, is therefore a key step: any time gain is a gain of survival!

Improve the assessment and treatment at the hospital
After the treatment of the acute phase (Thrombolysis and/or angioplasty), a balance sheet will be performed at the hospital to get started a treatment adapted to cardiovascular risk factors and heart function of the patient. There is also scope for improvement, as “about 30% of patients with myocardial infarction, especially if they are older, do not enjoy all of the requirements recommended”, regrets the high authority of health.

This report includes, in addition to conducting critical reviews to assess cardiac function, research and support of any diabetes (only 20% of infarction patients have a known diabetes) and/or a smoking (40% of patients). The systematic screening for diabetes after the acute phase to discover 17% of diabetics not known! These two situations in the absence of proper diabetes treatment or withdrawal, increase significantly the risk of recurrence and mortality and should be better supported by health professionals.

Once the heart function and assessed risk factors, cardiologists prescribe today said “BASI” treatment that combines four types of drugs:
Beta blocker (for hypertension),
Antiplatelet drug (to slightly ease the blood);
Statin (lower bad cholesterol)
(Another antihypertensive) converting enzyme inhibitor.

They may also prescribe cardiac rehabilitation in the effort to relieve the patient, prolong his life and avoid complications (recurrence, stroke, heart failure…).

Drug therapy significantly improved for 10 years. However, they are still too rarely administered to seniors, while their beneficial effects are yet demonstrated.

After the hospital, the follow-up is vital!
After cardiac arrest, getting started at the hospital “BASI” treatment and rehabilitation, medical follow-up will correct in the long term risk factors and continue to prevent complications. Still too many diabetic patients are not sufficiently balanced (20-40%), almost for 75% of hypertensive patients have controlled hypertension, only one-third of patients with a cholesterol problem have a standardized assessment, obesity is progressing (20% of the adult population)…

In the case of myocardial infarction, therefore absolutely tracked by his doctor (at least every 3 months) and his cardiologist (at least once per year) for:
Search and reduce cardiovascular risk factors (such as smoking, high blood pressure, diabetes, elevated cholesterol, obesity, lack ofphysical exercise, unbalanced diet); Keep the medication “BASI”.

A therapeutic education program, proposed by the cardiologist, is a definite plus. According to the HAS “after 6 weeks of cardiac rehabilitation, 95% of patients taken in charge took a professional activity and 92% have improved their quality of life (daily life, leisure and sport)”. Four years later, these patients have “two times less cardiovascular events (complications and deaths) and twice fewer hospitalizations”.

So after a myocardial infarction can be more often resume it a completely normal life, provided you have a healthy way of life, to follow the recommendations of its caregivers and to regular and assiduous way his medication. Myocardial infarction is a serious accident, but if the patients and health care professionals participate in improving its management, mortality is expected to still fall and the quality of life improving postinfarction.

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