Surviving a heart attack in rural
IN our prior columns, we have explored the general theme of access to good quality health care in Jamaica. We have discussed various obstacles and opportunities to improve the quality of health care delivery in Jamaica while making same equitable.
Health care inequity remains a vexing problem, not only in Jamaica but across the globe. A well known concept in health care is the Pareto principle, which basically opines that 20 per cent of the population (usually the more affluent) have access to 80 per cent of health care resources, leaving 80 per cent of the population to scramble for only 20 per cent of health care resources.
The picture is even more dire for the poorest 20 per cent who have access only to five per cent of health care resources. This inequitable distribution of health care resources is seen between countries (rich versus poor countries) and within countries (rich versus poor individuals or communities).
In Jamaica, we see a similar pattern between the more developed urban centres like Kingston and Montego Bay when compared to the more rural areas. While most of the health care resources and manpower are concentrated in the urban areas in Jamaica, rural areas of Jamaica where majority of the less affluent citizens live are largely devoid of any advanced health care facilities and so have very limited access to care in life-threatening emergencies. We experience this reality often when patients have symptoms of heart attack in rural Jamaica. A similar case last week deserves mention. We do so with respect and admiration for the hard-working health care personnel in rural Jamaica who often must make do with extremely limited and handicapping resources.
Our doctors at the Heart Institute of the Caribbean (HIC) Heart Hospital received a panicked call from a doctor at one of the rural hospitals at around 1:00 am on New Year’s Day, 2021, concerning a 49-year-old man who presented at the hospital with excruciating chest pain, profuse sweating, and severe breathing difficulties.
An electrocardiogram was obtained which showed a massive heart attack in progress. Without a cardiologist and lacking the standard tools for managing a heart attack, the likelihood of death for this young man was relatively high. To improve his chances for survival and limit injury to his heart muscle, a cooperative and coordinated care plan between our team at HIC Heart Hospital and the doctors at the rural hospital was critical. This was more remarkable happening on New Year’s Day at 1:00 am when most facilities had only skeletal staff on duty.
THE HEART DISEASE PROBLEM IN JAMAICA
Cardiovascular disease is the leading cause of death in Jamaica and around the world. In the USA, despite advanced care and more ready access to care, one person dies every 36 seconds from cardiovascular disease.
About 655,000 Americans die each year from heart disease, representing one in every four deaths in the USA. A significant number of these deaths result from heart attacks. According to the Centers for Disease Control and Prevention (CDC) in Atlanta, three heart attacks occur in America, every two minutes, resulting in more than 800,000 people having a heart attack in the USA each year. For 200,000 of these individuals, it would be their second or more heart attack, a reminder that those who have previously had a heart attack are at an increased risk of having another heart attack.
The number of people having heart attacks each year in Jamaica is not known, but using population and risk factor data, we estimate that nearly 7,500 individuals in Jamaica suffer a heart attack in any given year. With limited infrastructure and lack of adequately trained personnel, the risk of death or major disability from a heart attack in Jamaica is significant. That risk multiplies for individuals in rural Jamaica where infrastructure and manpower deficits for managing heart attacks are dire.
For anyone having a heart attack, rapid medical attention is the only option that may save and preserve life. There are immediate and delayed consequences of a heart attack that can be greatly attenuated by urgent intervention. Much of the adverse consequences of a heart attack are driven by how much of the heart muscle dies. With rapid, appropriate, and aggressive intervention to open the blocked artery, the heart muscle can be preserved, limiting the damage and other adverse outcomes.
Much of the permanent heart muscle damage can be avoided if proper treatment is delivered within four hours of onset of a heart attack. However, when treatment is delayed beyond six hours, the amount of heart muscle that can be saved drops off significantly. After about 12 hours, the damage is usually irreversible. In rural Jamaica, this is an ever-present problem and can only be ameliorated by robust collaboration and coordination between poorly equipped and poorly resourced public facilities and better resourced private centres of excellence for cardiovascular care.
URGENT AND APPROPRIATE RESPONSE SAVES LIVES
Timely response and appropriate intervention are key to saving lives and minimising heart muscle damage