Early Heart Attack Care Program Saves Lives, Resources

Heart attacks are the leading cause of death in the United States. Each year, more than 600,000 people suffer heart attacks-and nearly one third of them die. Although physicians and researchers have made tremendous strides in treating cardiovascular disease during the past 40 years, these measures have not translated into a meaningful reduction in heart attack deaths.

However, a physician at St. Agnes Hospital in Baltimore, MD, has developed a new strategy for treating heart attacks that shows tremendous promise for preventing many heart attack deaths. Raymond D. Bahr, M.D., calls this new strategy Early Heart Attack Care (EHAC). It is a strategy that is catching on across the country and becoming a significant movement in health care today.

Prevention: The Heart of the Matter

"EHAC is really two things. First, it is a common sense movement that recognizes that early symptoms of a heart attack occur in 50 percent of all heart attack patients, and that these early clues allow time for preventive measures to take place," he says. "Further, it is an education process that is designed to change behavior and attitudes. It teaches that heart attacks can be prevented."

Centering on Chest Pain

The second aspect of EHAC requires that patients with heart attack symptoms be evaluated and treated in a Chest Pain Center (CPC). A CPC is a dedicated area with two to four beds and is usually located within an emergency department. The CPC is supported by diagnostic services that allow for rapid evaluation of patients. CPCs bring together emergency department physicians, nurses, cardiologists and technicians who work as a team to establish a comprehensive management plan for patients with chest pain.

"The emphasis is on providing a user-friendly facility with standardized diagnostic and treatment programs that together provide more efficient and effective evaluation and more appropriate and rapid treatment

of patients with chest pain," Bahr says. "Chest pain centers also serve as a point of entry into the health care system to evaluate and treat other medical problems, as well as a transformation point to a healthier lifestyle."

CPCs also make efficient use of a hospital's financial resources, according to Bahr. As many as 70 percent of patients admitted to traditional inpatient coronary care units (CCUs) have not had a heart attack. Ruling out a heart attack in a chest pain center rather than a CCU costs one fourth to one-half as much.

"This could translate into billions of dollars saved in the United States each year if this approach were adopted at all hospitals," Bahr says. "And, as many as 150,000 lives could be saved annually."

The EHAC Movement

The primary goal of the EHAC movement is public awareness that heart attacks have beginnings that can occur weeks before the actual attack. EHAC centers on intervention during these "beginnings" and prevention of acute myocardial infarction and cardiac arrest. Waiting until cardiac arrest is too late, according to Bahr.

"EHAC shifts the paradigm to focus on acute prevention through the recognition of prodomal (precursory) symptoms of impending heart attack," he says. "Prodomal symptoms such as mild chest pain or stuttering chest pain are identified as a major risk factor for heart attack. Adults tend to ignore this warning a lid put themselves at risk for death."

Attacking the Future

Bahr has been leading a campaign to increase awareness about the FHAC strategy and the importance of chest pain centers. The EHAC program is now taught in 1,000 hospitals nationwide, and half a million people have learned about F FIAC through Bahr's public-service tape, which is available free-of-charge at some video stores, baseball stadiums, high schools, colleges and libraries.

There are currently about 700 chest pain centers. The first CPC opened at St. Agnes Hospital in 1980. 13ahr estimates that nearly all of the nation's 4,400 emergency departments will have one by the year 2000

"Heart attack is a public health problem that can be corrected," he says. "EHAC programs in conjunction with the CPC strategy shifts the paradigm of care from reaction to prevention, and saves lives and precious financial resources in the process.

For More Information

For more information about the Early Heart Attack Care program and Chest Pain Center concept, contact:
Raymond D. Bahr, M.D.
St. Agnes Hospital
900 Caton Avenue
Baltimore, MD 21229
Phone: 414.368.3200
Fax 410.368.3207
Web site: www.ehac.org

DCNHS Finance Division Offers Innovative Program to Affiliates

For the past 13 years, Daughters of Charity-sponsored organizations have had the opportunity to join an "obligated group" and take advantage of the lower transaction cost and interest rates associated with the System's AA rating. During that time, the System has completed more than 70 financings totaling more than $2 billion.

Now, DCNHS is offering selected affiliate member organizations the same opportunity to join an "expanded obligated group" (EOG).

"No one has ever taken an obligated group concept and expanded it for entities that they don't control 100 percent," says Jerry P. Widman, DCNHS senior vice president of finance. "What we are doing is creating an attractive credit structure to share with our strategic partners."

The first affiliate to become an EOG participating system is the Western Maryland Health System, the parent corporation of Sacred Heart Hospital and Memorial Hospital-both based in Cumberland, MD.

Widman describes the new EOG this way: "In group purchasing, when you increase the size of the group that is purchasing, you are able to drive better deals, better bargains and better terms and conditions. By expanding the obligated group concept, DCNHS is able to continue to drive better financial deals and arrangements."

In addition to tax-exempt bond offerings, DCNHS will offer EOG participating systems an increasing array of financial vehicles such as commercial paper and specialized loan programs.

"By the time the EOG program has reached its potential, we're going to be offering 15 to 25 different financing vehicles," Widman says.

To join the DCNHS expanded obligated group program, an affiliate organization must meet certain requirements, including strategic fit, maintaining an "A" rating, serving the poor and providing community benefits, making timely payments on debt, complying with bond covenants and conducting an annual audit.

Membership Has Its Advantages

The benefits of joining a DCNHS EOG are:

• Flexibility /operational autonomy
• Improved access to capital
• Lower interest rates
• Dispersion of risk
• Savings on transaction costs
• Ease of meeting financial ratios

The new EOG is designed to allow affiliate organizations the flexibility and autonomy they require to operate and respond to dynamic changes specific to their markets. And, the EOG offers financial products, vehicles and mechanisms that save money and that can only come from being affiliated with a larger system.

"What the EOG allows these entities to do is maintain their autonomy while still having access to many of the broader benefits of being affiliated with DCNHS," says Andy Pines of Smith Barney. "DCNHS is one of the strongest-if not the strongest-health care credits in the country, and the EOG allows affiliated organizations to reap the benefits of that strength."

One of the strongest benefits to EOG members is the use of DCNHS' AA bond rating. The highest rating is AAA, but no health care entities carry that rating on their own credit strength.

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