Haste, it is said, makes waste. But sometimes it can also save lives. Between 2003 and 2012, the death rate in Canada for patients hospitalized with heart attacks dropped a remarkable 40 per cent.
Hospitals in B.C. did even better. Heart-attack fatalities declined by 48 per cent during the same period. And the capital region鈥檚 main cardiac centre 鈥� Royal Jubilee 鈥� cut the mortality rate by an astonishing 53 per cent.
In terms of the sheer number of lives saved, this is one of the most dramatic advances in medical science since the introduction of antibiotics nearly a century ago.
And yet this turnaround has nothing to do with new drugs. Neither is it due to better surgical techniques or improved diagnostic procedures.
In the main, it was accomplished by just one innovation 鈥� getting patients treated more rapidly. Doctors call this the door-to-needle time 鈥� the number of minutes that elapse, after a patient suffers a heart attack, until treatment is started.
It has long been known that timeliness is critical in dealing with cardiovascular events such as strokes and heart attacks. The outer limit before irreversible harm is done to the heart muscle is between 60 and 90 minutes.
If treatment begins before this countdown runs out, the patient is likely to survive, and many emerge with no permanent damage. But in the past, it often took two hours or more before heart-attack victims began treatment.
First, there was the delay waiting for an ambulance. Second, it took time getting to hospital. Third, a team of cardiologists and specialized nursing staff had to be assembled. Fourth, diagnostic tests were required to see if a heart attack had indeed occurred. Last, clot-dissolving drugs had to be administered, or a device inserted to open blocked arteries. All of these steps took precious time.
Some of those delays, such as waiting for an ambulance and the ride to hospital, are unavoidable. And diagnostic tests must be carried out before treatment begins. If the patient hasn鈥檛 suffered a heart attack and clot-busting drugs are administered unnecessarily, internal bleeding could occur that might cause a stroke.
But in B.C., a team of clinicians, working with staff at the Provincial Health Services Agency, found a way to collapse steps two, three and four.
Ambulances now carry electro-cardiogram machines, and emergency personnel are trained to carry out a diagnostic test en route to the hospital. B.C. has 36 of these high-tech vehicles on standby across the province.
If the ECG detects a heart attack, staff radio ahead and a cardiac team is ready to begin treatment as soon as the ambulance arrives. The time saved enables many patients to be treated in 60 minutes or less. That has radically changed the outlook for heart-attack victims.
There are, of course, other factors, such as diet and exercise, that improve the chance of survival.
When U.S. president Dwight Eisenhower suffered a major heart attack in 1955, newspapers of the day showed him sitting up in hospital eating a cholesterol-laden breakfast of bacon and eggs. No wonder the fatality rate was higher in those days.
Still, with no fanfare or public acclaim, our health-care providers have gone a long way to taming one of our most feared, and deadly, diseases.
Credit for this accomplishment goes to the B.C. Health Ministry, to the Provincial Health Services Agency, to regional authorities and to the caregivers who made it happen. They came up with an ambitious plan and drove it through by force of will.
It鈥檚 not every day we get a chance to thank our public service for a job well done. This is assuredly one of those times.
See Lawrie McFarlane's column: Tough decisions paid off in hospital system
