NEWS LETTER

INDIAN SCENARIO
INDIA IS GLOBAL CAPITAL OF CAD - ABOUT 60% OF GLOBAL CAD DEATHS OCCUR IN INDIA STEMI IS ONE OF THE MOST LETHAL PRESENTATIONS OF CAD MYOCARDIAL DAMAGE BY STEMI IS TIME DEPENDANT TIMELY THROMBOLYSIS IS CORNER STONE OF TREATMENT IN STEMI PRIMARY PCI IS TALKED AS PREFFERED MODALITY OF TREATMENT BUT INDIA HAS FINANCIAL AND LOGISTIC CONSTRAINTS SO THROMBOLYTIC THERAPY IS TREATMENT OF CHOICE IN INDIA LESS THAN 10% STEMI PATIENTS UNDERGO PRIMARY PCI DUE TO LIMITED CENTRES OF EXCELLENCE, FINANCIAL CONSTRAINTS, LACK OF MEDICAL INSURANCE, POOR AMBULANCE SERVICES, TRAFFIC CONGESTION AND LOGISTIC HURDLES. EACH 30 MINUTE DELAY IN THROMBOLYSIS SHORTENS LIFE BY ALMOST ONE YEAR SO THROMBOLYSIS IS CONSIDERED AS THE COMMONEST REPERFUSION MODALITY THROMBOLYSIS GIVES MAXIMUM BENEFITS WITHIN ONE HOUR OF PRESENTATION AND HAS THEN A SHARP DROP OFF AFTER > 3 HOURS AND IS HAVING LEAST BENEFITS AFTER 12 HOURS OF PRRESENTATION TIMELINESS OF THROMBOLYSIS IS OF UTMOST IMPORTANCE IN MANAGEMENT OF STEMI ESPECIALLY IN OUR REGION

KASHMIR SCENARIO
9.7% PATIENTS ARE YOUNGER THAN 40 YEARS 13.2 % STEMI PATIENTS ARE NON KASHMIRIS USUALLY WORKING IN SECURITY FORCES AMONG STEMI PATIENTS ABOUT 80.3% ARE MALES AND 19.7% ARE FEMALES 39.8% STEMI PATYIENTS WERE NOT THROMBOLYSED DUE TO LATE PRESENTATIONIN TERTIARY CARE MEDIAN TREATMENT DELAY WAS ABOUT 250 MINUTES IN KASHMIR PREHOSPITAL DELAY IN TREATMENT OF STEMI WAS SEEN IN 83.8% OF THE PATIENTS IN WHICH DELAY DUE TO DECISION WAS SEEN IN 59% PATIENTS DEALAY IN REFERRAL WAS SEEN IN 16% OF STEMI PATIENTS DELAY IN TRANSPORTATION OF STEMI PATIENTS WAS SEEN IN 25% OF PATIENTS HENCE OVERALL 44.7% STEMI PATIENTS PRESENTED LATE DUE TO DIFFICULTY IN DIAGNOSIS AT PERIPHERAL HEALTHCARE LEVELS IME IS MUSCLE MAJOR EFFORTS ARE NEEDED TO DECREASE PREHOSPITAL AND IN HOSPITAL DELAYS 65.4% OF STEMI PATIENTS ARE FROM RURAL AREAS IN WHICH 50.3% STEMI PATIENTS HAVE DELAY OF <6 HOURS 9.9% STEMI PATIENTS HAVE DELAY OF 6-12 HOURS 39.8% STEMI PATIENTS HAVE DELAY OF >12 HOURS 44.7% STEMI PATIENTS WERE DELAYED FOR TREATMENT DUE TO MISINTERPRETATION OF SYMPTOMS AND ECG AND MISDIAGNOSIS AT PRMARY LEVELS RENDERING 40% STEMI PATIENTS INELIGIBLE FOR THROMBOLYSIS DUE TO LATE PRESENTATION DOOR TO NEEDLE TIME IN OUR CASE IS ABOUT 50 MINUTES WHEREAS IN WEST IT IS 32 MINUTES.HENCE PHARMACOINVASIVE APPROACH NTO STEMI CARE IS CONSIDERED BEST IN OUR SETTING WHERE THROMBOLYSIS IS PERFORMED AT PERIPHERAL LEVELS AND PCI IS DONE WITHIN 3 - 24 HOURS AT TERIARY CARE HSOPITALS AND THE RESULTS HAVE BEEN SEEN TO BE EQUAL TO PRIMARY PCI { ELUGUINDY AM 2014 44.7% STEMI PATIENTS WERE DELAYED FOR TREATMENT DUE TO MISINTERPRETATION OF SYMPTOMS AND ECG AND MISDIAGNOSIS AT PRMARY LEVELS

SAVE HEART INITIATIVE
SO WE DECIDED TO PROVIDE DOCTORS THE TECHNICAL AND DIAGNOSTIC SUPPORT / ASSISTANCE TO DIAGNOSE STEMI/ARRYTHMIAS AND INTERPRET ECGS VIA USE OF SOCIAL MEDIA GROUP - WHATSAPP. EACH 30 MINUTE DELAY IN THROMBOLYSIS SHORTENS LIFE BY ONE YEAR SO AVAILABILITY AND CAPACITY BUILDING TO USE STREPTOKINASE AT DH AND SDH LEVELS WAS ENSURED AND PROMOTED 40% STEMI PATIENTS INELIGIBLE FOR THROMBOLYSIS DUE TO LATE PRESENTATION, SO THE STEMI MANAGEMENT VIA SOCIAL MEDIA WAS ENCOURAGED RIGHT AT THE PLACE OF PRESENTATION AT SUB DISTRICT AND DISTRICT LEVELS.65.4% STEMI PATIENTS WERE FROM RURAL AREAS IN WHICH MEAN DELAY TO REACH TERTIARY CARE WAS ABOUT 250 MINUTES SO WHATSAPP GROUP WAS VERY HANDY IN DECREASING THIS DELAY BY PROVIDING EXPERT ADVISE TO MANAGE STEMI IN RURAL S SETUS ITSELF.PHARMACOINVASIVE APPPROACH WAS ADVOCATED AFTER TIMELY THROMBOLYSIS THERAPY AND REFERAALS WERE ARRANGED MANAGED AND STREAMLINED TO GREAT EXTENT VIA THIS FORUM.DIFFICULT CASES LIKE STEMI WITH CHB STEMI WITH VT STEMI WITH SHOCK WERE HANDLED AT PERIPHERAL LEVELS BY PROVIDING DUE GUIDANCE AND EXPERTISE VIA WHATSAPP GROUP.WELLENS SYNDROME AND WPW SYNDROMES WERE DETECTED TIMELY AND INTERVENED APPROPRIATELY AND IT WAS ENSURED THAT THEY ARE NOT LOST TO FAULTY REFFERALS.MOST OF THE LETHAL ATRIAL AND VENTRICULAR ARRYTHMIAS ARE BEING DISCUSSED AND MANAGED AT PERIPHERAL HOSPITALS CORTESY WHATSAPP GROUP ENSURING LEAST REFFERALS, SAVING EXPENDITURE TO PATIENT , SAVING COST OF TERTIARY CARE BED TO THE EXCHEQUER