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A Race Against Time

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Datuk Dr Rosli Mohd Ali   Chief Clinical Officer & Senior Consultant Cardiologist, National Heart Institute of Malaysia

Benjamin Franklin once said, “Lost time is never found again.” While the founding father of the United States might not have had heart attack on his mind when he uttered these famous words, they couldn’t be more apt when describing said medical condition. Consultant cardiologist Datuk Dr Rosli Mohd Ali couldn’t agree more.

‘Time is muscle’

“Many people may say ‘time is money’ but for us cardiologists, ‘time is muscle’,” quips Datuk Dr Rosli. Elaborating on his statement, he explains, “Simply put, a heart attack arises from a blood clot. Now, clots don’t typically develop in the arteries. But when bits of cholesterol gradually accumulate in the artery lining over time, what’s known as fatty or atherosclerotic plaques will form. Should the outer shell of these plaques rupture, their inner core become exposed to the blood. This, in turn, triggers the blood’s clotting mechanism – hence, the blood clots.”

As tiny as these blood clots are, the harm they pose can be huge. “When an artery is blocked by a clot, blood flow to the heart ceases or significantly decreases. No blood flow means no oxygen and nutrients. No oxygen and nutrients means damage to the muscle (also known as myocardial infarction). And if the clot isn’t removed in time, the heart muscle will die. ”

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Tick tock…

Surely, the damage is reversible with the right treatment? “Unfortunately, no. It’s irreversible. Dead tissue cannot recover. The window of opportunity is 0-6 hours. After 6 hours, the heart muscle would already be dead so performing angioplasty (a procedure to open up the blocked blood vessel) on the patient at that time may be pointless. Therefore, it is so crucial to treat patients as quickly as possible. The faster they are treated and revived, the higher their chances of survival. In fact, for every 15-minute delay in getting a blood vessel to open up results in a 7.5% increase in risk of death,” Datuk Dr Rosli emphasizes.

Commenting on the medical scene in Malaysia, he says, “Approximately 25% of heart attack patients die before they can reach the hospital.” When asked about the possible reasons, he explains, “Many patients seek medical assistance late. Whether it’s due to denial or a lack of awareness, they tend to brush off their heart attack symptoms. By the time they do come to the hospital, it’s already too late.”

“Another reason could lie with hospitals. The National Heart Institute (also called Institut Jantung Negara, IJN) offers angioplasty services 24/7 but lots of other hospitals do it either on a case-to-case basis or within office hours. Then of course, there’s the bad traffic in Malaysia. Ambulances are often delayed by jams. We do have efficient ambulance and hospital services, but as with everything, there’s always room for improvement. ”

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Introducing MySTEMI

This improvement that Datuk Dr Rosli speaks of comes in the form of the MySTEMI programme. “As you may have guessed, the ‘My’ in MySTEMI stands for Malaysia whereas ‘STEMI’ refers to ST segment elevation myocardial infarction – a term which doctors use for a classic heart attack.”

“Heart attack patients in Western countries normally arrive at the hospital within 30-90 minutes from the onset of chest pain. Malaysians, on the other hand, clock in at an average of 4 hours. And when they do reach the hospital, it may be one which doesn’t offer angioplasty! This just adds to the delay. This is why MySTEMI is necessary. Under this programme, we formed a hub-and-spoke concept whereby hospitals that don’t offer angioplasty (these are called ‘spoke’ hospitals) will transfer their patients to a ‘hub’ hospital, which has the facility ie, cardiac catheterization laboratory to perform angioplasty.”

Delving further into the hub-and-spoke concept, he says, “Let’s say a patient checks in to a ‘spoke’ hospital with a case of heart attack, the hospital will give him aspirin to reduce his blood clotting risk before contacting a ‘hub’ hospital. The ‘hub’ will, in turn, alert its catheterization lab staff and doctors to stand by while the ‘spoke’ sends the patient over.”

A success story

Citing statistics, Datuk Dr Rosli says, “With the implementation of the MySTEMI programme, we’ve seen improvement in a number of aspects. In IJN alone, doctors are able to treat99% of heart attack patients in less than 90 minutes (starting from the time patients check into a ‘spoke’ hospital to when they are given angioplasty). Previously, it was only 68% of patients.”

“The programme was launched about two years ago. That time, we managed to treat 70 patients only. Last year, we did 150. This year, we’re anticipating 200 plus people. As you can see, we’re picking up. Of course, this wouldn’t be possible without teamwork. I’m glad that a national programme like MySTEMI is accepted by all parties eg, universities, government and private hospitals,” he concludes proudly.

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As of now, hospitals participating as ‘spoke’ centres are:

  • Hospital Kuala Lumpur
  • Hospital Tengku Ampuan Rahimah Klang
  • Hospital Putrajaya
  • Hospital Banting
  • Hospital Selayang
  • Hospital Sungai Buloh
  • Hospital Shah Alam
  • Hospital Kajang.
  • Hospital Ampang

For the ‘hubs’, we have:

  • National Heart Institute (IJN)
  • University Malaya Medical Centre
  • Hospital Serdang
  • Hospital Universiti Teknologi MARA
  • Universiti Kebangsaan Malaysia Medical Centre

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