Temporomandibular Joint Disorders Associated With Psoriatic ...

stemi heart attack treatment :: Article Creator

Pa. Hospital Ends STEMI Treatment In Latest Service Cuts

UPMC McKeesport Hospital's future is uncertain after staffing, service cuts and financial pressures

By Kris B. MamulaPittsburgh Post-Gazette

MCKEESPORT, Pa. — City parking garages stuffed with cars and stores thriving up and down the block is Mike Kostyzak's memory of McKeesport when he was a child.

"McKeesport was no joke," said Mr. Kostyzak, 62, who grew up in Glassport, a neighboring mill town 3 miles away.

Today, McKeesport is a husk of what it was, with more than one out of four residents living in poverty and an ongoing campaign to demolish boarded-up storefronts in the once bustling downtown.

As the city faded over the past 10 years, UPMC McKeesport Hospital cut its workforce and medical services, shrinking its role as an economic pillar in the struggling Monongahela Valley town.

"Buddy, as much as I hate to say it, it's all about the money," said Mr. Kostyzak, 62, who opened Zak's Bicycle Shop in 2009 on a main drag in McKeesport after getting laid off from a radiator shop. He said he can't afford health insurance. "It's the sad reality."

In recent years, McKeesport Hospital, located 15 miles southeast of Pittsburgh, closed its two-bed intensive care unit, referring critically ill patients to other hospitals.

The hospital has also ended emergency care for the most serious heart attacks, called ST Elevation Myocardial Infarction or STEMI, which mostly tend to be more severe and dangerous. About 40% of heart attacks are STEMIs, according to the Cleveland Clinic.

Civic leaders worry that financial pressures will force the eventual closure of UPMC McKeesport Hospital, but a spokeswoman says that's not in the plans.

Heart disease is the leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. Snaking a catheter into the arteries that feed blood to the heart muscle has long been the most effective way to treat heart attacks caused by a clot, which are often fatal.

Doctors inflate a tiny balloon to open clogged vessels, trying to limit "door to balloon time" to less than 90 minutes to save heart muscle from dying. Every minute counts.

But not every hospital has the staff and equipment to do the procedure, and knowing which ones offer it can be difficult for patients, especially during a medical emergency.

"It should not be a matter of chance or geography that determines what kind of care a heart attack patient receives," Thomas R. Aversano, associate professor of medicine at Johns Hopkins University, wrote in a landmark 2002 study that found that emergency angioplasty was superior to clot-busting drugs in the treatment of the most serious heart attacks.

UPMC acquired McKeesport Hospital in 1998 and soon discontinued maternity care, but other services were added over the years.

The hospital continues to operate a busy emergency room — 26,470 patient visits in 2020 — and recently opened a 27-bed addiction medicine unit.

Despite these changes, the hospital reported an operating loss of 10% in fiscal 2022, according to the Pennsylvania Health Care Cost Containment Council, with flat net patient revenue between 2019 and 2022 as hospital admissions statewide sunk to 1.37 million, the lowest since 2008.

Fewer hospital admissions means less operating revenue.

UPMC McKeesport Hospital offered emergent angioplasty as recently as 2020. UPMC's Mercy, Presbyterian and Shadyside hospitals in Pittsburgh continue to offer the care along with East and Passavant hospitals, in the suburbs of Monroeville and McCandless.

Quick access to emergency angioplasty is not just an issue for people living in McKeesport; rural EMS services take "significantly longer" to get patients with a STEMI heart attack to definitive care than in urban areas, according to a 2023 study in the journal Prehospital Emergency Care.

Heart angioplasty, for example, is not available at all in Greene, McKean and other rural counties.

Today, UPMC McKeesport Hospital sends STEMI patients to other hospitals, and even though emergent angioplasty is no longer done at UPMC McKeesport, a system webpage still listed the service as of Friday. UPMC spokeswoman Lisa Lombardo said the page would be updated.

"Patients can absolutely seek emergent care at UPMC McKeesport," cardiologist Matthew Harinstein, chief medical officer at the hospital, is quoted on a UPMC website. "There is no sense in driving half an hour outside of your community to get care when a minute or two may make all the difference in your survival."

A declining number of cases, a shortage of physician heart specialists and the need for volume to assure staff proficiency in doing the procedure were among the reasons for ending the service, Ms. Lombardo said.

Also as of Friday, a UPMC web page for the system's family medicine residency program listed an intensive care unit at UPMC McKeesport Hospital among its assets. The beds were recently repurposed to better meet patient needs, Ms. Lombardo said.

UPMC said the scaling back of medical services in McKeesport doesn't affect care because the hospital can quickly divert critically ill heart patients to other hospitals — often while the ambulance is enroute — a practice recommended by the American Heart Association in 2004. Bill Miller, chief of the McKeesport Ambulance Rescue Service, said his service had been apprised of the changes and had altered transport priorities accordingly.

But heart attack victims don't always arrive by ambulance, and studies have shown that a number of issues, including emergency room overcrowding and time of day or night of the emergency, can delay definitive heart care, prompting the warning among physicians that "time is tissue."

"Current treatment strategies aim to provide optimal care while minimizing delays in order to improve clinical outcomes," according to a 2017 analysis that appeared in the journal Cardiology Research. "There still remains a wide range of logistic problems, including patient delays and in-hospital transfer, which can render treatment goals unachievable."

UPMC McKeesport is not alone in cutting medical services. Heritage Valley Health System shifted many services out of its Kennedy hospital to its other facilities effective July 1, and Bradford Regional Medical Center in McKean County closed most of its inpatient units in 2021, a year after merging into the Upper Allegheny Health System.

Hospitals across the U.S. are facing many of the same fiscal challenges as UPMC in McKeesport, including having to pay premium wages for nurses and other temporary help while reimbursement for services from health insurers has been flat.

"Economic factors, the wind down of COVID-19-related government spending and subsidies, government and third-party payor reimbursement pressures and hits to investment portfolios have placed many hospitals in a vulnerable position," Chicago-based law firm McDermott Will & Emery wrote in a new hospital industry report.

Downsizing at McKeesport hospital mirrors the deterioration of the city over the past decade: between 2013 and 2023, the number of licensed beds at UPMC McKeesport was trimmed 11.2%, to 205, while the workforce was cut 24.3%, to 854 people, according to UPMC figures.

And even those numbers could continue to shrink. New UPMC revenue bond documents indicate an average of just 150 beds staffed daily at the hospital.

During the same decade, McKeesport's population slid 17%, to 17,082 while the poverty rate more than doubled, to 27.4% from 11.2%, as the community's biggest medical concerns shifted from diabetes to opioid abuse.

Nevertheless, UPMC McKeesport Hospital, which traces its roots to 1894, remains a pillar in the community.

"The hospital is a vital resource in the region," said Robert Johnson, board chair of the Mon Yough Area Chamber of Commerce, who was born at McKeesport Hospital, "a vital, vital piece of this valley. For a lot of people in town, this is their hospital."

Nearby in White Oak, where the borough is getting ready to mark its 75th anniversary, Mayor Ina Jean Marton worries that UPMC McKeesport could close — much like UPMC Braddock Hospital did in 2010 because of operating losses.

"It's important we have a local hospital," she said. "It's essential. We all go to it."

Ms. Lombardo said there were no plans to close UPMC McKeesport. The hospital is hiring for 150 open positions, even as the bed count shrinks.

"We expect fewer beds because care is shifting to outpatient," she said. "We're doing it to meet those needs. The population is changing, their needs are changing."

"It's a vibrant hospital," she said.

Frye Honored For Heart Attack Patient Care

HICKORY — Frye Regional Medical Center, a Duke LifePoint hospital, has received the American Heart Association's Mission: Lifeline STEMI Receiving Gold Plus achievement award for implementing specific quality improvement measures to treat patients who suffer severe heart attacks.

The hospital was also awarded the Mission: Lifeline NSTEMI Gold achievement award for implementing specific quality improvement measures to treat heart attack patients more efficiently and rapidly.

Every 40 seconds, someone in the U.S. Has a heart attack. Heart disease is the No. 1 cause of death for men, women and people of most racial and ethnic groups in the United States. Studies show patients can recover better when health care providers consistently follow treatment guidelines.

Mission: Lifeline puts the expertise of the American Heart Association to work for hospitals nationwide, helping ensure patient care is aligned with the latest evidence- and research-based guidelines. As a participant in Mission: Lifeline, Frye Regional qualified for these awards by demonstrating its commitment to improving quality care.

People are also reading…

"Frye Regional is committed to improving cardiovascular care by adhering to the latest treatment guidelines and streamlining processes to ensure timely and proper care for heart attacks," said R. Norman McDonald, M.D., an interventional cardiologist and Frye Regional's cardiology section chief. "The Mission: Lifeline program makes it easier for our teams to put proven knowledge and guidelines to work on a daily basis, which helps us ensure more patients have the best possible chance of survival and experience longer, healthier lives."

According to McDonald, a heart attack with a completely blocked coronary artery is called a STEMI (ST-segment elevation myocardial infarction). STEMI heart attacks tend to be more severe with a greater risk of serious complications than other types of heart attack. An NSTEMI, or non-STEMI heart attack, is caused by a partial blockage of blood flow to the heart and requires timely treatment.

Depending on factors such as how blocked the coronary artery is and the severity of the heart attack itself, treatment may include a non-surgical procedure (percutaneous coronary intervention) to open up the narrowed or blocked section of the artery, restoring blood flow to the heart. Severe blockages may need coronary artery bypass grafting, which can be performed close to home by the experienced heart team at Frye Regional.

The Frye Regional Heart Center is the first Duke Health heart affiliate in western North Carolina. Backed by the resources of the Duke Heart Center, Frye Regional gains access to current Duke training and staff education, evidence-based guidelines and practices when it comes to heart and heart-related issues.

"Frye Regional is pleased and honored to once again receive national recognition in heart care," said Philip Greene, MD, chief executive officer of Frye Regional Medical center. "This year's awards will be added to a long list of achievements in cardiovascular health including past Mission: Lifeline accolades and our most recent Get With The Guidelines Heart Failure Gold Plus quality award, also from the American Heart Association."

Additionally, the accredited Chest Pain Center at Frye Regional Medical Center has been recognized with the NCDR Chest Pain – MI Registry Platinum Performance Achievement Award from the American College of Cardiology, which identifies hospitals that have demonstrated a sustained, higher standard of care for heart attack patients.

"We are pleased to recognize Frye Regional Medical Center for its commitment to caring for those in their community who need cardiovascular care," said John Warner, M.D., past president of the American Heart Association and CEO of The Ohio State University Wexner Medical Center. "Hospitals that follow the American Heart Association's quality improvement protocols often see improved patient outcomes, fewer readmissions and lower mortality rates — a win for health care systems, families and communities."

To learn more, visit MyFryeRegional.Com.

Get the latest local business news delivered FREE to your inbox weekly.

One-month Of COVID-19 Lockdown Cost Heart Attack Patients Up To Two Years Of Life

Sophia Antipolis, 8 June 2023: Patients who had heart attacks during the first COVID-19 lockdown in the UK and Spain are predicted to live 1.5 and 2 years less, respectively, than their pre-COVID counterparts. That's the finding of a study published today in European Heart Journal – Quality of Care and Clinical Outcomes, a journal of the European Society of Cardiology (ESC).1 The additional costs to the UK and Spanish economies are estimated at £36.6 million (€41.3 million) and €88.6 million, respectively, largely due to absence from work.

"Restrictions to treatment of life-threatening conditions have immediate and long-term negative consequences for individuals and society as a whole," said study author Professor William Wijns of the Lambe Institute for Translational Medicine, University of Galway, Ireland. "Back-up plans must be in place so that emergency services can be retained even during natural or health catastrophes."

Heart attacks require urgent treatment with stents (called percutaneous coronary intervention or PCI) to open the blocked artery and restore the flow of oxygen-carrying blood. Delays, and the resulting lack of oxygen, lead to irreversible damage of the heart muscle and can cause heart failure or other complications. When a large amount of heart tissue is damaged, the heart stops beating (called cardiac arrest) and this can be fatal.

During the first wave of the pandemic, about 40% fewer heart attack patients went to hospital2,3 as governments told people to stay at home, people were afraid of catching the virus, and some routine emergency care was stopped. Compared to receiving timely treatment, heart attack patients who stayed at home were more than twice as likely to die,4 while those who delayed going to the hospital were nearly twice as likely to have serious complications that could have been avoided.5

This study estimated the long-term clinical and economic implications of reduced heart attack treatment during the pandemic in the UK and Spain. The researchers compared the predicted life expectancy of patients who had a heart attack during the first lockdown with those who had a heart attack at the same time in the previous year. The study focused on ST-elevation myocardial infarction (STEMI), where an artery supplying blood to the heart is completely blocked. The researchers also compared the cost of STEMIs during lockdown with the equivalent period the year before.

A model was developed to estimate long-term survival, quality of life and costs related to STEMI. The UK analysis compared the period 23 March (when lockdown began) to 22 April 2020 with the equivalent time in 2019. The Spanish analysis compared March 2019 with March 2020 (lockdown began on 14 March 2020). Survival projections considered age, hospitalisation status and time to treatment using published data for each country. For example, using published data, it was estimated that 77% of STEMI patients in the UK were hospitalised prior to the pandemic compared with 44% during lockdown. The equivalent rates for Spain were 74% and 57%. The researchers also compared how many years in perfect health were lost for patients with a STEMI before versus during the pandemic.

The cost analysis focused on initial hospitalisation and treatment, follow-up treatment, management of heart failure and productivity loss in patients unable to return to work. For example, the cost applied to a STEMI admission with PCI was £2,837 in the UK and €8,780 in Spain. Heart failure costs were estimated at £6,086 in year one and £3,882 in all subsequent years for the UK. The equivalent figures for Spain were €3,815 (year one) and €2,930 (each subsequent year).

The analysis predicted that patients who had a STEMI during the first UK lockdown would lose an average of 1.55 years of life compared to patients presenting with a STEMI before the pandemic. In addition, while alive, those with a STEMI during lockdown were predicted to lose approximately one year and two months of life in perfect health. The equivalent figures for Spain were 2.03 years of life lost and around one year and seven months of life in perfect health lost.

In the UK, the extra cost of one STEMI during the pandemic, compared to before, was £8,897 which included £214 for the National Health Service and £8,684 in work absenteeism.6 Based on an incidence of 49,332 STEMIs per year, reduced access to PCI during the first month of lockdown was projected to cost an extra £36.6 million (€41.3 million) over the lifetime of these patients.

For Spain, the extra cost per STEMI during lockdown was estimated at €20,069. Based on an annual STEMI incidence of 52,954 STEMIs, reduced access to PCI during March 2020 was projected to cost an additional €88.6 million over these patients' lifetimes. Work absenteeism was the main contributor, costing an extra €23,224 per patient (€81,062 pre- vs. €104,286 post-pandemic). However, this was partially offset by lower costs of heart failure hospitalisations since more STEMI patients died during lockdown.

Professor Wijns said: "The findings illustrate the repercussions of delayed or missed care. Patients and societies will pay the price of reduced heart attack treatment during just one month of lockdown for years to come. Health services need a list of lifesaving therapies that should always be delivered, and resilient healthcare systems must be established that can switch to emergency plans without delay. Public awareness campaigns should emphasise the benefits of timely care, even during a pandemic or other crisis."

ENDS

Authors: ESC Press OfficeTel: +33 (0)489 872 075

Email: press@escardio.Org

Acknowledgements: The study was conducted on behalf of We CARE, which started after the first COVID-19 lockdown and aims to help all stakeholders restore and sustainably deliver effective and timely cardiac care.

Funding: This work is supported by a Science Foundation Ireland Research Professorship Award to W. Wijns (15/RP/2765) and Science Foundation Infrastructure Research Grant supporting M. Lunardi. Simon Eggington, Natalie L. Papo and Silke Walleser-Autiero are employees of Medtronic, which provided financial support to WeCare. Wing Tech Inc. (Jan B. Pietzsch) provided consulting services to Medtronic.

Disclosures: Please see the paper.

References and notes

1Lunardi M, Mamas MA, Mauri J, et al. Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries. Eur Heart J Qual Care Clin Outcomes. 2023. Doi:10.1093/ehjqcco/qcad025.

Link will go live on publication:

https://academic.Oup.Com/ehjqcco/article-lookup/doi/10.1093/ehjqcco/qcad025

2Mafham MM, Spata E, Goldacre R, et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet. 2020;396:381–389.

3Pessoa-Amorim G, Camm CF, Gajendragadkar P, et al. Admission of patients with STEMI since the outbreak of the COVID-19 pandemic: a survey by the European Society of Cardiology. Eur Heart J Qual Care Clin Outcomes. 2020;6:210–216.

4Wadhera RK, Shen C, Gondi S, et al. Cardiovascular deaths during the COVID-19 pandemic in the United States. J Am Coll Cardiol. 2021;77:159–169.

5De Rosa S, Spaccarotella C, Basso C, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J. 2020;41:2083–2088.

6Numbers add up to £8,898, rather than £8,897, due to rounding.

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

European Heart Journal – Quality of Care and Clinical Outcomes

European Heart Journal – Quality of Care and Clinical Outcomes publishes original research and topical reviews from health scientists around the world, focusing on quality of care as it affects cardiovascular outcomes in hospitals, as well as at national and international levels.

Journal

European Heart Journal - Quality of Care and Clinical Outcomes

Types of Congenital Heart Defects