Rapid heart-attack response boosts survival

Aug 17 2016

A lifesaving treatment protocol pioneered in the Hunter New England Health (HNE Health) district, which delivers clot-busting drugs to heart attack victims before they reach hospital, has been shown to improve survival rates for people in regional and rural areas.

The Pre-Hospital Thrombolysis (PHT) program enables paramedics to administer specialised treatment to patients, including the clot-busting drug Tenecteplase, after consulting with a cardiologist via smartphone. Treatment can begin immediately and improvement is often seen before a patient arrives at hospital.

The quick response is vital in opening a blocked artery and preventing permanent heart muscle damage, especially for patients who are remote from a major treating hospital. 

A landmark study assessing the effectiveness of the first five years of the PHT program appears in the August edition of the Medical Journal of Australia. It shows the survival rate of patients who received the treatment (measured after 12 months) was 93 per cent – the same as city patients who live close to a major hospital equipped with a cardiac catheterisation laboratory.

Lead author Professor Andrew Boyle, a John Hunter Hospital cardiologist and co-leader of HMRI’s Cardiovascular Research Program, said PHT reduced the tyranny of time and distance when it came to treating acute heart attacks.

“Time equals muscle – that’s our saying in the world of cardiology. The quicker you get the blocked artery open, the better the chances are of salvaging heart muscle that is dying, minute by minute,” Professor Boyle said.

“If the artery is blocked for more than six hours, most of the damage is already done. In many areas of our district, patients are six hours away from the major cardiac treating facility, which is the John Hunter Hospital.

“Delivering clot-dissolving drugs up front in the ambulance at the onset of a heart attack significantly improves a patient’s chances of survival.”

PHT is used on patients suffering a heart attack caused by a coronary artery blockage, usually due to a blood clot. Paramedics use an electrocardiography (ECG) machine to do a diagnostic test and send the result via smartphone to the on-call cardiologist, who then consults with the paramedics.

“Once we know the patient is on the way, we can activate the entire cardiac catheterisation team before the ambulance arrives, saving crucial time by bypassing emergency department admission and getting the patient on the operating table immediately,” Professor Boyle said.

The PHT protocol has been adopted across regional and rural NSW and other states are moving to implement the program. NSW Ambulance has fitted every emergency ambulance with the 12-lead ECG machines required to diagnose patients and more than 3,500 paramedics have been trained to provide early advanced cardiac treatment.

The protocol operates in parallel with the Pre-Hospital Assessment for Primary Angioplasty (PAPA) progam, which provides similar early diagnosis for heart attack patients in metropolitan areas.

“Paramedics have demonstrated they are well-positioned to safely provide this level of world-class health care for cardiac patients,” NSW Ambulance Cardiovascular Manager Paul Stewart said.

“This PHT program is of particular benefit to patients in regional and rural communities, who would previously have had to rely on transfer to a major centre for this type of treatment.”

PHT program pioneer Professor Peter Fletcher, a John Hunter Hospital Senior Staff Specialist and former Director of Cardiology, said collaboration between Health and NSW Ambulance was a groundbreaking and integral aspect of the program.

“The cooperation between clinicians and ambulance paramedics is a unique and very positive initiative and has created a protocol that is now being assessed and adopted for other conditions, including stroke,” Professor Fletcher said.

He said the study had shown that adverse factors which had previously led to poorer outcomes for heart attack patients living outside metropolitan areas could be overcome.

“The development of the PHT model has allowed cardiac patients across NSW, regardless of whether they live in metropolitan, regional or rural areas, to receive the best possible care in the shortest possible time,” Professor Fletcher said.

“It has saved many lives and will save many more in years to come.”

The Pre-Hospital Thrombolysis protocol was developed with the support of Hunter New England Health, NSW Ambulance, Hunter Medical Research Institute and the University of Newcastle.