What does the best
possible outcome for Heart Attack or Stroke look like?
I was at The Cottage Life Show in Toronto last weekend,
promoting CPR and AED’s (Automated External Defibrillator) for the
family cottage. A couple stopped by the
booth to ask a few questions. Both were healthy and happy and I would have
never guessed that less than a year ago he had suffered a significant myocardial
infarction. The reason he looked and felt so good – immediately upon the onset
of symptoms 911 was called and he was taken directly to the cardiac
catheterization lab at Sunnybrook Hospital and emergency angioplasty was
performed well within the 90 minute target time.
Over the past six years I have met many patients that have
been treated within the 90 minute door to balloon time (DTB) window that is the
target for all STEMI (ST Elevated Myocardial Infarction) programs and it would
be impossible to tell that any of them had recently had a significant MI. Most patients that make the 90 minute DTB
window have suffered little or no loss of heart function and little or no
permanent damage to the heart muscle. Return to a good quality of life often
takes only a few weeks and return to work often occurs even sooner than many
patients would have hoped for. Many
STEMI patients have told me that they “feel better now than they have in a
couple of years.”
Last summer I met a neighbour walking his dog. As he approached I didn’t even notice his
slight limp and wouldn’t have guessed he had recently suffered a stroke unless
he had told me. His story was similar to the stories of most stroke patients
that are home within a few weeks with little or no noticeable deficit – both he
and his wife instantly recognized what was happening and wasted no time in
calling 9-1-1. The Paramedics transported
him directly to the Regional Stroke Centre where he received thrombolytic
therapy within two hours of the onset of symptoms.
These two real world examples are what I would define as “the
best possible outcome” for Heart Attack and Stroke. After a short stay in
hospital both patients were home, physically and neurologically intact,
enjoying a very good quality of life and quite willing to buy green bananas.
What does it mean for
patients, families and taxpayers when the best possible outcome is achieved?
For spouses, children, grandchildren, friends and co-workers
to have a person they care about come through an acute cardiovascular event
with little or no permanent deficit and able to return quickly to a pre-event
quality of life is priceless.
For our overburdened healthcare system the price of not consistently achieving the best
possible outcome for heart attack and stroke is one that we can no longer
afford to pay. When Heart Attack and Stroke are allowed to run their course and
visit the maximum damage upon the patient the result is lengthy hospital stays
including many days or weeks in intensive care, the costliest level of care. Many patients are unable to go directly home
but must go to a rehabilitation facility where they re-acquire simple skills
needed to manage daily living. Return to anything like their pre-event quality
of life, including return to work, may take months or years or may never
happen. Many patients will have an intimate and costly relationship with the healthcare system for the rest of their life.
The investment required to educate older adults (and for that
matter everyone) how to recognize and respond to significant cardiovascular
emergencies is miniscule by comparison. In a world where communication and
knowledge sharing is omnipotent and omnipresent it astounds me how few of the
adults that attend my classes have even a rudimentary knowledge of heart attack
and stroke recognition and management. I do know that for two dollars for every
adult over age 50 we could go a long way toward providing each of them with the
knowledge and tools to achieve the best possible outcome for Heart Attack and Stroke.
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