Cardiologists launch “Every minute counts” campaign

In a heart attack, every minute counts, literally. And much more than previously thought: new data discussed during the conference launching the national heart attack management campaign, "Every Minute Counts," demonstrates that the now outdated "golden hour" limit of 120 minutes should no longer exist, because prompt medical intervention is even more essential than expected, and because every 10-minute delay results in an additional 3% mortality rate. The new campaign, launched by "Il Cuore Siamo Noi – Fondazione Italiana Cuore e Circolazione Onlus," with the patronage of the Italian Society of Cardiology, will highlight the importance of two key strategies for shortening access times for angioplasty with stenting, an essential procedure for reopening coronary arteries affected by a heart attack. On the one hand, citizens must learn to immediately recognize the typical signs of a heart attack (such as retrosternal constriction), and on the other, emergency services must minimize any possible delays by having vehicles equipped with an electrocardiograph for immediate diagnosis, ensuring the fastest possible transfer to centers with a cath lab. If the patient arrives at a hospital where angioplasty is available, they do not need to go through the emergency department but directly to the cath lab, similar to a fast-track procedure at the airport, saving approximately 20 minutes there alone. When the diagnosis of heart attack is made before the patient is admitted to the hospital (pre-hospital diagnosis based on symptoms and electrocardiogram), immediate activation of the cath lab not only reduces treatment delays but also reduces mortality.

"We already know that prompt rescue in the event of a heart attack is essential," explains Francesco Romeo, director of the chair and school of specialization in cardiology at the University of Tor Vergata in Rome, and president of Il Cuore Siamo Noi - Fondazione Italiana Cuore e Circolazione Onlus. "It has been known for years, for example, that an intervention after 90 minutes from the onset of symptoms can even quadruple the mortality rate of patients. The latest clinical studies, which now involve thousands of patients, have shown, however, that there is no 'threshold time' that allows us to discriminate between timely intervention or not, but that the patient's prognosis continuously worsens as the delay in treatment increases. This is why 'every minute counts' and new data show that this is even more true especially in those patients who present in very serious conditions, with loss of consciousness: in these cases, in which mortality is unfortunately still 50-70% instead of around 3% as in classic heart attacks, for every 10-minute delay in treatment there are three more deaths out of 100 patients treated".

"However - adds Ciro Indolfi, president of the Italian Society of Cardiology and director of Cardiology-Hemodynamics and UTIC at the Magna Grecia University of Catanzaro - even among patients who arrive at the Emergency Room in more stable conditions, the delay has a negative impact, albeit slightly less. Losing time in the event of a heart attack, therefore, always causes an unacceptable increase in mortality: the longer you delay, the greater the amount of cardiac muscle that is lost and replaced by fibrous, non-contractile tissue, with important consequences for the patient's quality of life. Time is muscle. In the event of a heart attack - adds Indolfi - it is essential to access primary angioplasty as soon as possible, a minimally invasive procedure that 'frees' the artery responsible for the heart attack and places a stent that keeps the diseased vessel open. In Italy, 158.689 coronary angioplasties and 37.135 primary angioplasties are performed each year, a value that has allowed us to exceed the ceiling of 600 primary angioplasties/1.000.000 inhabitants defined as the European quality standard (609 pPCI/1.000.000 inhabitants). All the most recent guidelines of the European Society of Cardiology underline that angioplasty is the first-choice intervention for STEMI infarction and above all that delays in access are the most significant index of the quality of care”.

"There is a delay due to the patient and one due to the emergency system - continues Romeo -. The goal of the information and awareness campaign 'Every minute counts' is precisely to reduce both to a minimum. We must ensure that everyone knows how to recognize the more and less known signs of a heart attack: an oppressive pain in the center of the chest, lasting more than 20 minutes, arising at rest and in some cases radiating to the left arm or jaw represents the most typical manifestation, but often the heart attack presents itself in a more subtle way, such as abdominal pain or in the back of the chest never felt before, without pain but with the sudden onset of shortness of breath at rest, with fainting or in many other ways. In these situations, which are more difficult to identify, it is best for the patient, worried by the persistence of the symptoms, to call for help as soon as possible or go to the nearest emergency room to rule out the presence of a heart attack. From the moment of first contact with the doctors, delays due to emergency management must be reduced: the guidelines indicate that the diagnosis of heart attack must be made in less than 10 minutes”. It is therefore essential that emergency vehicles have an electrocardiogram on board and that centers not equipped with a haemodynamics room for angioplasty can guarantee the fastest possible transfer to a center where the intervention can be performed: “If this is not possible, thrombolysis is started, but transfer must be guaranteed as soon as possible. Finally, in centers equipped with haemodynamics, the patient with heart attack must be taken directly to the haemodynamics room, without going through the Emergency Department: this strategy allows you to save a good 20 minutes during patient management. And treatment times are reduced even further if the cardiologist for primary angioplasty is already in the hospital, even at night, thus avoiding the call on call which is the cause of further delays in treatment”, concludes Romeo.