PATIENTS with acute chest pain and potentially life-threatening cardiac emergencies are a common problem and pose a challenge for clinicians in Jamaica. Most institutions lack the expertise or the infrastructure to properly manage acute heart attacks and other cardiac emergencies, which are common in the diagnosis of cardiac conditions resulting in uncertainty and delay.

Time for diagnosis and time for treatment are critical in preserving heart muscles following a heart attack, and therefore critical in saving the lives of patients with heart disease. Individuals with acute cardiac symptoms could be facing a potentially life-threatening emergency and must ideally be evaluated by competent cardiologists as a matter of utmost urgency. For such evaluation to be meaningful, it must occur in an adequately equipped medical facility with competent cardiovascular technologists.

Regrettably, Jamaica in 2015 does not have an adequate number of cardiologists, properly trained cardiovascular technologists or adequately equipped medical facilities to respond to the cardiovascular needs of the population, particularly in emergencies or urgent circumstances. Effectively, most patients end up receiving sub-optimal care and many lives have been endangered or lost needlessly. Many of those who have survived an acute cardiovascular event have ended up with significant degrees of disability, often due to delayed diagnosis and less than optimal treatment. This situation can be remedied by changing our approach to the way emergency and urgent cardiovascular care is delivered in Jamaica, recognising our inherent difficulties and challenges.

INFORMATION DEFICIT

One key factor is information deficit. Many individuals are still unfamiliar with the classification of doctors and the varying skills, levels and expertise. To many, a doctor is a doctor when it comes to chest pain or other cardiovascular complaints. The reality is that cardiac emergencies are a lot more life threatening than most surgeries, and therefore must demand the attention of the best cardiologists. This is the most important predictor of outcome.

FINANCIAL CONSTRAINTS

While information is critical, perhaps, for most, finance is the most significant obstacle to accessing the best-informed care in a cardiac crisis. With acute cardiovascular complaints in an emergency, the most important thing is to make a quick diagnosis so that proper treatment recommendation can be made. Solving the problem of access must therefore solve the problem of affordability. Open access to patients with acute cardiovascular complaints will be one of the most significant innovations to the way cardiovascular care is delivered in Jamaica.

SPECIALISED TREATMENT

The need for faster, more accurate and more cost-effective diagnosis and treatment in part has driven the concept of specialised treatment centres for chest pain and cardiovascular diseases such as the Heart Institute of the Caribbean (HIC) This concept is further enhanced by the development of Chest Pain Centers within the facility since September 15, 2014, to formalise and enhance responsiveness in acute life-threatening situations. This strategy relies on the assignment of the right clinical personnel to the task of rapid intervention in patients with chest pain and heart attacks and to triage such patients to identify low-risk and high-risk patients. An effective programme must be able to evaluate all patients with equal thoroughness under the assumption that any patient with chest pain could potentially be having a heart attack or other likely life-threatening cardiovascular condition.

In 2005, the Heart Institute of the Caribbean (HIC) embarked on a mission to improve access and quality of cardiovascular care to the people of the Caribbean. We are of the view that cardiovascular care delivery in Jamaica would be greatly enhanced if we engineer a process of open access to rapid and prompt coronary angiograms at the time of acute cardiac complaint and for those patients most at risk.

In response to the access issues in cardiovascular emergencies, we have designed a new model that grants open access to emergency heart care to the most vulnerable group of patients. This became effective April 10, 2015 and is defined as follows:

The HIC Chest Pain Center will now offer free doctor’s evaluation for anyone with chest pain or cardiac complaints after hours. No need for such people to go and wait hours on end at A&Es. They can come to the Chest Pain Center at HIC for free emergency physician evaluation. If the doctor determines they need an angiogram, it is offered free, except they have to purchase the low cost Rapid Angiokits that are available through various suppliers here in Jamaica.

Free angiograms will now also be offered at HIC to the following groups of patients:

All patients in Jamaica identified to be having a heart attack or chest pain or other cardiac complaints strongly suggesting a heart attack.

All patients hospitalised at any hospital in Jamaica who have been told that they would need an angiogram during that hospital stay.

All patients presenting at any A&E in Jamaica who are told that an angiogram would be needed because of their complaints.

Courtesy of the HIC Foundation, these patients will incur no fees for the procedure and the doctors’ fees will be waived as well at HIC. They would be required to procure a low-cost rapid angiokit which they can get from any vendor in Jamaica

We believe that an open and accelerated access to coronary angiograms without financial consideration would lead to a quick diagnosis, and allow clinicians to define proper treatment strategies and give patients early diagnosis and families; well deserved comfort and peace of mind. We also believe that by eliminating the financial hurdle to diagnosis, patients can apply their limited and already stretched financial resources towards treatment. For those who would require no further treatment or intervention, they would have been spared enormous expense and granted peace of mind.

Professor Ernest Madu, founder of the Heart Institute of the Caribbean, is an internationally acclaimed cardiologist and expert on innovative health solutions. HIC is a centre of excellence for cardiovascular care in the English-speaking Caribbean. Please send questions and comments to emadu@caribbeanheart.com.