Introduction: Community Message in Acute Myocardial Ischemia
Raymond D. Bahr, MD, FACP, FACCMedical Director
The Paul Dudley White Coronary Care System
St. Agnes HealthCare
Baltimore, MD
The Second National Congress of Chest Pain Centers in Emergency Departments was held in Phoenix, Ariz, October 6-8, 1995. It was jointly sponsored by the Arizona Heart Institute and the Healthwest Regional Medical Center in association with the Paul Dudley White Coronary Care System at St. Agnes HealthCare, Baltimore, Md.
Its primary purpose was to examine the current strategy to develop Chest Pain Centers in Emergency Departments and seek ways to deliver the early heart attack message in more effective ways. Each speaker was given the charge to incorporate in the context of their presentation the July 1995 editorial in Lancet by Dr. Richard Horton, entitled "The Interpretive Turn,"(1) in hope of crystallizing a visionary interpretation of current knowledge of heart attacks at the end of the conference.
We dedicate this conference to Henry McIntosh, MD, for his "take charge" attitude in bringing the issue of accredited emergency training programs to this crucial point of our development. His help in developing the survey questionnaire (see page 10) aimed in getting input on opinions of cardiologists on prodromal symptoms of a heart attack is acknowledged. The opinions expressed and the results of this questionnaire demonstrate a mandate for change in our present strategy in the war against heart attack deaths in the United States.
"Finding the right message" seen in this light becomes the most important issue confronting us in changing our present approach to Early Heart Attack Care (EHAC). Interpreting the facts at hand is a reasonable way to proceed and puts this endeavor on a learning curve very similar to what took place with the CCU development over the last 30 years. The CCU development gave us the "left hook" with the knowledge to extend these principles to the community. Finding the right message becomes then the knockout punch. Thus, the CCU and the Chest Pain Emergency Departments are very much related. The ultimate coronary care unit has always been stated by the American Heart Association to be in the community. The learning curve of the chest pain movement will be even more powerful than the CCU development in that it will involve not only emergency physicians, primary care physicians, cardiologists, and critical care nurses, but also involve more community members such as pharmacists, rehabilitation departments, industry, and those existing in educational systems. The chemistry of these multiple players will accelerate the process.
References
1. Horton R. The interpretive turn. Lancet. 1995;346:8966. Editorial.
Return to Index of Articles for Clinician;
Volume 14.4
- Faculty Listing 3
- Introduction: Community Message in Acute Myocardial Ischemia 4
- Concept of Community Chest Pain Centers in Emergency Departments 5
- Reawakening Awareness of the Importance of Prodromal Symptoms in the Shifting Paradigm to Early Heart Attack Care (EHAC) 7
- The Role of Emergency Medicine in the Future of American Medical Care: A Summary of the Josiah Macy, Jr, Foundation Conference 12
- From ACC/AHA Guidelines to Best Practice: Can "Acute MI Report Cards" Save Lives?Measuring Quality of Care for Patients With Cardiovascular Disease 16
- Improving Lay Responses to Cardiovascular Emergencies and the Potential of Shifting the Paradigm to Early Heart Attack Care 18
- National Survey of Chest Pain Centers Rationale and Potential Results 21
- Outpatient Rule-Out Myocardial Infarction in Observation Units 22
- Reducing Time to Thrombolytic Treatment 24
- Intervention Programs to Reduce Patient Delays in Acute Myocardial Infarction 29
- Public Education Using the Early Heart Attack Care Program Shawnee Mission Medical Center 31
- School Component: Early Heart Attack Care Program Development and Evaluation 33
- Educational Strategies to Prevent Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction 36
- Precipitating Factors in Acute Cardiovascular Disease 41
- Use of Myocardial Perfusion Imaging in the Emergency Department for Risk Stratification 44
- The Evolution of Chest Pain Centers: The Impact of Technological Advances on the Evaluation of Patients With Possible Acute Ischemic Coronary Syndrome 47
- Critical Pathways for Triage and Treatment of Chest Pain Patients in the Emergency Department 53
- Chest Pain Centers: An Emerging Model for the Emergency Evaluation of Chest Pain and Treatment of Acute Myocardial Infarction 56
- The Key to Success in the Chest Pain Emergency Department: The Observational Role of theNurse 59
- Triage in Moderate Risk Patients With Chest Pain: The Emerging Role of Real-Time Continuous ECG Monitoring 61
- Diffusion of Innovations: The Introduction and Impact of the Chest Pain Emergency
- Department and its Comparison to the Coronary Care Unit Development 64
- Economics of Chest Pain Centers: What Really Matters? 68
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