Along with the introduction and implementation of the American Heart Association's national initiative, Mission Lifeline, comes a focus on life-saving initiatives that will create a strong system of care to improve outcomes of heart attacks across the Mountain State.
"We need to have a very strong system of care, and it's necessary to improve the outcome of heart attacks," said Michele Boles, executive vice president of health strategies, Great Rivers Affiliate of the American Heart Association.
Dr. Carl McComas, board member of the Greater Rivers Affiliate AHA/ASA Board, shared challenges and ways to face those challenges experienced in West Virginia during a Nov. 1 press conference in Charleston to launch Mission Lifeline.
"If we all can come together, we can make a difference in the number of people whose lives are saved from a heart attack," McComas said. "Public education is the first link of this program."
Educating the public
"In my mind, this is a public issue and it requires everyone, not only at the table here in this room today, but it requires other key state holders to make this effort work," Yvonne Cook, president of Highmark Foundation, said.
McComas emphasized the importance of immediately dialing 911 for chest pain and other symptoms related to a potential heart attack.
"If you're having chest pain or some other related chest issue, seek immediate medical attention, preferably by calling the EMS," he said. "I think the figure is 50 percent of people who do not call 911 for chest pain.
"That's a bit of an issue."
According to McComas, the quicker the patient realizes their chest pain can be a life-threatening event and they seek help in calling 911 and EMS transports them to a hospital, the quicker care can be rendered.
Because West Virginia has the oldest population in America with the shortest life expectancy, McComas said, it can sometimes be a tough culture to crack, due to the fact that many of the elderly have called the Mountain State "home" their entire life.
"It's hard to tell them it's really important to take your blood pressure," he said. "We have a hard time educating people in this state."
Taking advantage of EMS
Providing optimal care at the scene and quick transport to hospitals that are capable of treating heart disease is another important step in eliminating West Virginia's rank as second in the nation in heart attack prevalence.
Ideally, McComas said, the patient is quickly taken to an appropriate hospital, placed on the table where a catheterization or emergency bypass surgery is performed, or a stint inserted, and the patient is sent on their way.
"Numerous studies have shown the quicker you get reperfusion to the myocardium, the better the outcome is," he said.
Reperfusion is a technique that restores blood flow to the heart muscle damaged during a heart attack.
Because West Virginia is a rural state and physical access by virtue of roads sometimes increases emergency medical service arrival time to 30 minutes or an hour, McComas said some patients end up driving themselves because they know it will be quicker.
"There are actually people driving themselves," he said. "They just drive themselves to the hospital with a heart attack or a stroke or whatever.
"They know it can take an hour or two for the EMS to get there. That's a difficult problem."
By calling the EMS instead, McComas said, it is much easier to phone ahead at the receiving hospital to relay symptoms and EKG results. With symptom and EKG information in hand, the receiving hospital is ready, alert and waiting to receive the patient.
Not only will the receiving hospital be ready with patient information, but the waiting period once the patient has arrived at the hospital will also be eliminated.
"Once you're at the hospital, you're immediately ushered back," McComas said. "You don't have to sit out front and wait three hours to get your insurance card scanned and all that stuff. You get immediate care if you call 911."
Improving door-in, door-out time
What's the No. 1 challenge West Virginia faces?
Patient delay, McComas said.
"Door-in and door-out times are way too long," he said.
According to McComas, several factors contribute to patient delay. Sometimes, counties don't have enough funding for EMS, which can make transporting a patient to the needed hospital a difficult and time-consuming task. Transportation by helicopter also is unpredictable, with weather preventing helicopters from flying many days a year. Patients also call to report other symptoms, but not chest pain.
McComas also said sometimes hospitals can miss the "window of opportunity" by not realizing the patient's true ailment.
"Someone with a stroke will be admitted to the hospital," he said. "Then, the next day, (the hospital) realizes it was a stroke and says, ‘Oh, we need to send you to a stroke hospital.' They've missed the window of opportunity.
"We have to work on that as well."
Having hospitals tuned in to the right care is another key factor, McComas said.
"Sometimes, hospitals think they're attuned to the right care, but are using protocol that may be 20 or 25 years old," he said. "We need to identify which hospitals do a good job and which ones do less than an optimal job.
"If they're doing less than a good job, let's work with them."
McComas said he would like to see the total process — from the patient calling in to the cath lab — take no more than one hour.
The cath lab is the department in a medical facility that specializes in cardiac catheterization, which is a procedure to examine blood flow to the heart and test how well the heart is pumping.
Educating EMTs, paramedics
West Virgnia native Mayme Roetig, MSN, a registered nurse at Duke Medical Center, said while Mission Lifeline's objective is to decrease mortality and morbidity in patients, it is really about making sure the system works.
Roetig's passion for research in heart attacks and acute coronary syndrome stems from her own personal experience: losing her brother at age 37.
"The U.S. (health care system) is like the Wild, Wild West," she said. "We've been working with one community at a time with the American Heart Association's staff as the backbone of the neutral party that works in these competitive cities."
Vital in improving the health care system is everyone having a plan born from collaboration, parallel processing and coordinating, Roetig said.
"If everyone has a plan, we can get the artery open the best way possible and then hopefully return those patients to their families and their communities," she said. "This is creating a legacy for all West Virginians."
Signs of improvement
While cardiovascular disease is still the number one killer in West Virginia and across the nation, there has been progress.
"We're educating people, hospitals have improved, people are smoking less than they have previously, controlling blood pressure has improved and controlling diabetes has improved," McComas said. "So that has all helped to reduce the risk of heart attack and stroke as well."
Other supporters are optimistic, too.
"The American Heart Association's Mission Lifeline simply put is going to save lives here in West Virginia," said Kim Tieman of the Claude Worthington Benedum Foundation.
And the new program will include entire communities.
"With Mission Lifeline, every one of us has a part to play to see that this happens here in West Virginia," said Bob Pepper, chair elect for the American Heart Association Charleston board of directors.