TN Doctors Save Heart Attack Patients with Hub-and-Spoke Model

Chennai: With the rapid advancement of technology, healthcare in remote areas has improved significantly compared to the past, when technical gadgets and applications were unavailable, making access to medical care more challenging. Today, with the help of WhatsApp, doctors can efficiently manage remote healthcare centers through the "hub and spoke therapy model."

A recent study by the Institute of Cardiology at Madras Medical College has shown how a simple WhatsApp-based system can save the lives of heart attack patients in critical situations. The study showed that around 188 small hospitals in Tamil Nadu that lacked specialized facilities were connected to 18 bigger hospitals with expert cardiologists. 

Through WhatsApp, the cardiologists guided healthcare workers from remote areas by reading the ECG, patient history and test results, suggesting drugs, procedures and deciding when to transfer patients for advanced treatment. 

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Over five years, this system helped treat 71,000 patients. Nearly one in five patients who suffered a heart attack and reached a major hospital had first been treated at a smaller facility with the help of this WhatsApp support. 

In the second phase of the study, done with six hub hospitals, the doctors saw a remarkable increase in the proportion of people who got any intervention from 52.6 per cent in 2019 to 87.1 per cent by 2022, as reported by The Indian Express. The data is from the cardiac care policy implemented by the government of Tamil Nadu.

The study, published in the Indian Journal of Medical Research, revealed how such models can help patients suffering from a heart attack or any other complications get more accessible care across India. It is worth noting that young people these days are experiencing more heart disease. 

According to Dr. G Justin Paul, the cardiologist who designed the model and also leads the state government’s heart attack management programme team told the Daily, "The sooner a person can undergo a procedure to open up a heart blockage or at least get a medicine that can help in dissolving the clot, the more muscles we end up saving. Sadly, a very small proportion of people receive these timely interventions."

“There are two types of heart attacks. A STEMI (ST-elevation Myocardial Infarction) is a major heart attack where the clot blocks blood flow completely to a part of the heart, resulting in the muscles dying. Non-STEMI is referred to as a minor heart attack. Once the heart muscles die, there is no way of reviving them. However, there is now enough evidence to show that giving the clot-dissolving drug immediately and then doing the procedure within 24 hours is also equally effective. While most hospitals may not be able to do the procedure, they can certainly give the drug and then move the patients to the bigger hub hospital,” said Dr Paul.

"In fact, the WhatsApp chat platform also helps the smaller centres share transfer protocols and coordinate patient care with the bigger hospitals. This system of care worked in Tamil Nadu because of the availability of cardiologists in several Government hospitals, even in those that did not have a catheter lab prior to the study. This may not be true for all of India. However, the model may be modified and adopted,” said Dr Paul.

In the first cluster with 12 hub hospitals, including the key Madras Medical College, the proportion of patients undergoing the stenting procedure after getting the clot-dissolving medicine streptokinase increased from 9.1 per cent to 33.2 per cent. The proportion of patients able to receive the procedure within hours of a heart attack also increased from 5.7 per cent to 9.7 per cent.

The results from the second cluster were even more impressive. While the proportion of patients undergoing the procedure immediately remained the same, those getting the procedure after having received the medicine increased from 0.9 per cent to 5.3 per cent. The proportion of deaths also reduced from 8.5 per cent to 5.8 per cent.

“The cost of angioplasty in a private hospital — which can range from Rs 1.5 lakh to Rs 6 lakh — can be a deterrent. But, more importantly, not all hospitals have the facility to conduct the procedure. This is the reason many may not be able to get the procedure within a few hours of the heart attack. While the study used the less costly streptokinase that is given as an infusion, newer drugs can also be used. These one-shot injections are costly at present, but the price may be brought down by governmental action, much in the same way as the stent prices were lowered,” said Dr Paul.

“Any revascularisation (restoring blood supply) saves heart muscles and reduces the odds of death. Hence, organising timely revascularisation for major heart attacks should be a governmental and societal responsibility,” he added.

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