Reducing emergency treatment time for heart attacks by almost half


The National Heart Institute or Institut Jantung Negara (IJN) provides efficient emergency treatment for heart attacks. The region’s leading centre for cardiovascular and thoracic care has over the last few years managed to improve its “door-to-balloon” time, which is the duration between patient arrival to the reopening of the blocked artery, from 85 minutes to 45 minutes despite an increase in the number of heart attack cases.

The average time achieved by IJN is well above the recommended time of within 90 minutes for Primary Percutaneous Coronary Intervention (PCI), as detailed by the American College of Cardiology/American Heart Association. PCI is a procedure of re-opening the blood vessels with a balloon, or angioplasty and deploying a stent that causes the blood vessel to remain open.

A heart attack can occur when any major blood vessels supplying the heart becomes completely blocked. In the majority of cases, the blood vessel becomes progressively narrow due to chronic diseases such as high blood pressure, diabetes, high cholesterol and smoking. These narrowed blood vessels could suddenly become completely blocked due to microscopic tears within the blood vessels leading to blood clot formation which then causes a heart attack.

Early management of a heart attack is necessary to reduce the damage caused to the heart muscle by the lack of blood supply during a heart attack, hence the recommended door-to-balloon time of within 90 minutes. IJN has managed to reduce the time to Primary PCI for heart attacks through a collaboration program with Hospital Kuala Lumpur (HKL) since 2014.

“Heart attack patients that were brought to HKL received initial treatment and were then referred to IJN for Primary PCI when required. This follows a series of processes and procedures that were lengthy and redundant before the patient is brought to IJN and eventually sent to the catheterisation laboratory for the procedure,” the emergency physician and manager at the IJN Emergency Department, Dr Farina Mohd Salleh (picture) said in an article by The Health Plus.

Dr Farina said the only government hospital that offers Primary PCI is Hospital Serdang, which is about 30 minutes away.

Hence, she said it does not make sense for HKL to send heart attack patients to Hospital Serdang as IJN is just “next door”.

She said both hospitals decided to collaborate in a pilot heart attack-network project called HISNET (Hospital Kuala Lumpur-IJN STEMI Network) as part of the hospitals’ commitment to provide the best quality treatment for patients.

Started in Oct 2014, the HISNET program enables HKL to send patients with heart-attacks straight to IJN with a single phone call activation system to the IJN Emergency Department.

“When a person complains of chest pain and is taken to HKL, they will have to do an ECG  (electrocardiogram) in the emergency department to make sure that he or she is having a heart attack. Only after the diagnosis is confirmed, will they start the process to send the patient to IJN for treatment.

“HKL has improved processes on their side to diagnose the heart attack, give early treatment and send the patient within 30 minutes. They have to be very efficient,” Dr Farina said.

She said IJN has a hotline for HKL to call in informing about diagnosis and tell that they are sending a patient to IJN.

“When we receive the call, the cardiologist and catheterisation laboratory and staff are activated to prepare to receive the patient even before the patient arrives. Early preparation cuts down the time to treatment drastically. When the patient arrives in IJN Emergency Department, he or she is quickly prepared for the procedure and rushed to the catheterisation laboratory, ready to receive Primary PCI,” she said.

The HISNET project not only made the referral process for heart attack patients in HKL to IJN more efficient, it also improved the efficiency of IJN’s internal processes in managing patients who come direct to IJN with a heart attack.

She added that the IJN-HKL successful collaboration has been a catalyst for other hospitals in Klang Valley to implement various heart attack-networks, which is now called the MySTEMI  network.

Dr Farina advised patients to seek early treatment at a hospital, preferably in IJN if close by, rather than wait at home when they have symptoms of chest pain.