Heart Institute's first LHIN program in Ontario for emergency heart attacks

Sep 18 2009

Heart attack victims who live outside Ottawa's urban centre now are part of the University of Ottawa Heart Institute's (UOHI) far-reaching emergency life-saving program, ensuring urgent standardized treatment regardless of geography and, for the first time in Ontario, throughout an entire regional health district.

Heart Institute specialists have collaborated with physicians, nurses, paramedics and CEOs in 16 regional and community hospital sites, developing the first Local Health Integration Network (LHIN)-wide program in Ontario for emergency heart attack.

"This means earlier treatment in smaller centres and a faster transfer to the Heart Institute for patients if a major heart attack is diagnosed," said Dr. Michel Le May, Director, UOHI Coronary Care Unit. "Survival of heart attack patients is increased, emergency room congestion is eased and vital wait times are reduced. Every minute counts when the coronary artery is blocked, and this program is designed to save lives."

Dr. Le May's research shows that in-hospital deaths at UOHI dropped 50%, to less than 5% among patients suffering a type of heart attack called a ST-Elevation Myocardial Infarction (STEMI). STEMI is one of the most common forms of heart attack. The Heart Institute STEMI program includes pre-hospital diagnosis by paramedics and pre-treatment by clot-busting drugs (thrombolytics) for patients who cannot immediately receive emergency angioplasty-restoring blood flow by opening the artery with a balloon insert through a catheter.

In some cases, receiving emergency treatment within a very fast time frame remains difficult for many potential heart attack patients living outside the urban and suburban environment. Teams at medical centres across the entire Champlain LHIN-within a 200-km radius of UOHI-are using the Heart Institute's protocols to both identify and speed the treatment of STEMI, then transfer high-risk patients immediately to the Heart Institute.

The Heart Institute's STEMI program evolved from trials led by Le May, whose research and protocol is acclaimed in Canada, the U.S. and Europe. Since 2005, a total of 1,550 STEMI patients have been treated at the Heart Institute where an emergency team, available 24/7, administers the best treatment to significantly improve chances of survival during a heart attack.

Results of Dr. Le May's research and trials have been published in the New England Journal of Medicine (2008; 353:231-40). Parts of the Heart Institute's program have been adopted as the standard in emergency heart attack treatment in several Canadian cities such as Kingston, Hamilton, Quebec City and Vancouver.

Traditionally, patients experiencing chest pain arrived at an emergency department to be examined by a hospital physician, and, in consultation with a cardiologist, a STEMI condition was diagnosed. This resulted in significant delays to treatment.

The STEMI program originated with a pilot study in 2001 by Dr. Le May and colleagues Dr. Justin Maloney, Medical Director of the Ottawa Base Hospital Paramedic Program and Dr. Richard Dionne, Assistant Medical Director of the paramedic program.

Dr. Robert Cushman, CEO, Champlain LHIN, said, "The University of Ottawa Heart Institute's collaborative and successful STEMI program is saving lives across our large geographic region. Essentially, the program will improve efficiency in the medical system, reduce wait times for the critically ill, and ease the pressure on our emergency rooms."