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​Managing heart attacks is a race against the clock – Hospitals must be prepared in advance

<p><span style="font-family: helvetica;"><img src="/nairobi/PublishingImages/Fellowship%20body%20image.jpg" alt="" style="margin: 5px;"/></span> </p><p><span style="font-family: helvetica;"><em>Inset: Dr Mzee Ngunga (centre), Interventional Cardiologist with other cardiologists at </em><em style="font-family: helvetica;"><em>A</em>ga Khan University Hospital&#39;s State-of-the-art Cathlab facility

</em>The increase of heart attacks in Kenya is worrying. Studies show that 25 per cent of medical admissions in the country are due to cardiovascular disease with heart attack, stroke and heart failure contributing to the majority. Cardiovascular disease (CVD) also accounts for 13 per cent of hospital deaths. The fact that Kenyans in their twenties and thirties are now experiencing heart attacks means we can no longer afford to ignore this growing risk to our future health and well-being.</span></p><p><span style="font-family: helvetica;">The heart is a muscle that pumps blood to the body including major organs like the brain and kidneys and also to itself. The coronary arteries supply blood to the heart. Any sudden blockage of a major coronary artery results to a heart attack. The most common causes of heart artery blockage is a blood clot. If the blood supply to the heart is not urgently restored, the heart may stop pumping putting and death follows.</span></p><p><span style="font-family: helvetica;"><strong>Signs of heart attack</strong></span></p><p><span style="font-family: helvetica;">Signs of suffering from a heart attack include sharp pains in the chest with a sense of impending doom. The distress may also be felt in the arms, in the jaws and in the neck. Sometimes, it feels like &#39;gas&#39; in the upper stomach, sweating and shortness of breath. Anyone suffering from these symptoms should seek urgent medical attention.</span></p><p><span style="font-family: helvetica;"><strong>Diagnosis and associated challenges</strong></span></p><p><span style="font-family: helvetica;">Unfortunately, many heart attacks are not diagnosed and do not receive timely treatment in Kenya. This is because patients, or caregivers may fail to recognize the importance of the symptoms and not seek assistance. The other challenges are poor accessibility of acute medical services for the majority of the population and financial barriers.</span></p><p><span style="font-family: helvetica;">Heart attack diagnosis and treatment is also hindered by lack of facilities in the country. At a minimum, this should be a hospital that can do an ECG, basic blood tests and administer medications known as thrombolytics, or “clot busters&quot;.</span></p><p><span style="font-family: helvetica;"><strong>Promising initiates to improve diagnosis and treatment</strong> </span></p><p><span style="font-family: helvetica;">Initiatives like the Heart Attack Concern Kenya (HACK) are moving to address these challenges with a protocol of &quot;systems of care&quot; for efficient management of heart attacks and integrated networks of facilities. The emphasis is to work with the government, ambulance services and medical societies to increase access to timely life-saving treatment.</span></p><p><span style="font-family: helvetica;">In addition to working with HACK and ensuring that there are systems in place, the Aga Khan University Hospital, Nairobi (AKUH) has been granted the Clinical Care Program Certification (CCPC) by the Joint Commission International making it a Centre of Excellence in the management of heart attacks.</span></p><p><span style="font-family: helvetica;">To receive this certification, the Hospital developed systems and care pathways to allow easy implementation of protocols in the treatment of heart attack patients. Inspectors from the Joint Commission International examined the hospital&#39;s records, quality control procedures, staff qualifications, equipment, facilities and overall management. This rigorous process took more than three years to complete. </span></p><p><span style="font-family: helvetica;"><strong>Managing heart attack</strong></span></p><p><span style="font-family: helvetica;">Once a heart attack happens, speed is of the essence as heart muscle begins to die within the first hour. The goal of treatment is to re-establish blood supply to the heart within 60 minutes. To beat the clock, AKUH put up a highly organized team of specialised nurses and doctors that can make quick diagnosis and provide expert treatment using clot busters, or specialized catheters to open the blocked artery. This team is available to provide this service 24 hours a day 365 days a year.</span></p><p><span style="font-family: helvetica;">A care protocol also had to be put in place. This includes a set of systems that enable early diagnosis, treatment and rehabilitation. For example, the medication required is kept in the Emergency Room (ER) and is given to the patient once the heart attack is diagnosed bypassing the need to go to the pharmacy for the medication. The care bundles ensure that no step is missed and only the critical aspects of care are adhered to.</span></p><p><span style="font-family: helvetica;">The protocol gives AKUH an edge in terms of team dynamics, preparedness, knowledge and training. Once a patient with chest pain is identified, the team knows where the ECG machine is kept and that there are timelines to get the ECG performed and interpreted. The team knows where the medication is kept and how its administered. The catheterisation laboratory (Cath Lab) is always on standby and can be activated within minutes to provide life-saving treatment.</span></p><p><span style="font-family: helvetica;">Since this team and systems were put in place, the hospital has treated over 100 heart attack patients without losing a single one. These protocols and organisational structures led to AKUHN being awarded a clinical care pathway certification for the treatment of heart attacks.</span></p><p><span style="font-family: helvetica;"><strong><em>By Dr Mzee Ngunga, Interventional Cardiologist, Cardiology Fellowship Training Director, and Head of Cardiac Care Unit, Aga Khan University Hospital Nairobi 

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