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Public release date: 25-Oct-2008
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Sophia Antipolis, 17 October 2008: Chest pain - or at worst a cardiac arrest - is invariably the prelude to one of the most critical episodes of health care. Acute cardiac care, that first emergency phase in which the chest pain is assessed and its cause treated, embraces a broad spectrum of diagnoses ranging from unstable angina to acute heart failure, from myocardial infarction (with or without ST elevation) to other life-threatening disorders of the heart.
Today in most countries of the world almost 50 per cent of patients in hospital for a cardiac condition began their treatment as emergency cases: chest pain at home . . . a cardiac arrest in the street. Thus, in a country like France, around 100,000 myocardial infarction patients from a total of 200,000 each year were first seen in an emergency cardiac care setting. In countries with higher rates of heart disease, the numbers are even greater.
The Working Group aims to establish the status of the Intensive Cardiac Care Unit (ICCU) as the correct place to treat all patients who need acute cardiac care, to develop guidelines for the ICCUs in Europe, and to establish acute cardiac care as a self-contained medical sub-specialty.
The clinical challenges facing the ICCUs and the specialty of acute care will be addressed at the Acute Cardiac Care 2008 congress, which takes place in Versailles, France, from 25-28 October. Details of story and interview opportunities for journalists can be found at the end of this press announcement.
1. Continuing high rates of mortality
Around 30 per cent of patients who have a myocardial infarction begin with a cardiac arrest. While there has been progress in improving overall mortality rates following acute myocardial infarction (AMI), survival rates when the arrest takes place outside hospital are no better than 5 per cent in most European countries. Survival rates are slightly better in the USA, mainly because of better public health campaigns and more defibrillators in public places. Survival rates for those undergoing acute cardiac care following chest pain are better than 95 per cent.
So, much depends on immediate intervention. "Resuscitation should begin within three or four minutes of the cardiac arrest," says Dr Danchin. "That's why it's so important to teach the basics of resuscitation to the whole population. And that should begin in schools."
2. The importance of timing
There has been little improvement in the time delay between the onset of symptoms and the first medical contact. "This is vital," says Dr Danchin. "We need to reopen the occluded arteries and that must be done very quickly. If you can do this within the first 60 minutes – the 'golden hour' – there is virtually no myocardial damage done." However, research data to be presented at the congress show that the median time between onset of symptoms and first medical contact is more usually 4-6 hours than one hour.
How can the time delay be shortened? A more efficient paramedical service will help, but is not sufficient. Dr Danchin believes complete public education is necessary: "If someone has prolonged chest pain of ten or 15 minutes, they really have to call someone right away."
3. The treatment of acute heart failure
The treatment of acute heart failure still lacks efficient medication. There have been improvements, but there is still a high rate of acute and sub-acute mortality in patients with acute heart failure. "We need new ways to manage these patients," says Dr Danchin.
Acute Cardiac Care 2008 will present new data on the way acute cardiac patients are managed, particularly in accordance (or not) with the latest guidelines. New analysis from the Euro Heart Survey's Acute Coronary Syndromes Registry will compare acute treatment in 2006/7 with clinical practice in 2000 and 2004. "Hopefully, there will have been improvements," says Dr Danchin.
The congress will also review the latest ESC guidelines on the treatment of AMI and emphasise that early emergency PCI (percutaneous coronary interventions via balloon angioplasty and stent) should be the "default strategy". "If it's not feasible to implement quick PCI," adds Dr Danchin, "our advice is that intravenous thrombolysis is the best alternative."
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