Timing is Everything: Heart attack treatment outcomes revealed

Srinagar, Jan 6: A first of its kind study conducted in Kashmir has underscored the life-saving potential of timely medical intervention for heart attack patients. The research, led by Dr Imran Hafeez, Additional Professor of Cardiology at SKIMS Soura, highlights stark differences in mortality rates between patients receiving early thrombolysis and those undergoing delayed Percutaneous Coronary Intervention (PCI).

Key findings of the study

The observational study carried out by a DM Cardiology Scholar at SKIMS Soura has revealed that heart attack patients treated with thrombolysis within the “golden hour”—the critical first hour after symptoms appear—had a remarkably low mortality rate of just 2.3 per cent (97.7 per cent survival). Conversely, patients who underwent delayed PCI experienced a significantly higher mortality rate of 41.7 per cent (58.3 per cent  survival). This alarming disparity emphasises the importance of prompt medical attention in improving survival outcomes for heart attack patients in the region.

In simpler words, if a person has a heart attack, lives more than an hour’s drive away from a tertiarycare hospital with Cath Lab facility, and receives thrombolysis (clot dissolving medicine), 98 of 100 will survive. In contrast, if they are just bundled up in a vehicle to reach a Cath Lab more than an hour’s drive away, only 58 out of 100 will survive.

Dr Hafeez explained that the primary focus of the study was to evaluate whether a pharmaco-invasive approach (thrombolysis, followed by PCI) is inferior to primary PCI for treating ST-segment elevation myocardial infarction (STEMI), a severe type of heart attack caused by a complete blockage of a major artery to the heart. “The results demonstrate that thrombolysis administered promptly can offer survival outcomes as good as primary PCI performed within the golden hour,” Dr Hafeez stated.

Addressing treatment delays in Kashmir

In the unique settings of Kashmir, timely treatment poses significant challenges. Most patients from peripheral regions cannot reach tertiary care hospitals within the critical window for primary PCI. Even in Srinagar, delays in accessing treatment remain a concern. The study analyzed three patient groups—those from peripheral areas, those living near Srinagar, and those within the city—to eliminate geographical bias.

Dr Hafeez noted that the study is an “eye-opener” regarding the delays patients face in reaching hospitals, both for thrombolysis and primary angioplasty. He stressed the need for greater awareness among both the public and healthcare providers about the urgency of heart attack treatment.

“If you have a patient with a heart attack, the priority should be to reach the nearest hospital and get thrombolysed,” he said. “This approach can save lives, especially when tertiary care facilities are inaccessible within the golden hour.”

The “Save Heart Initiative”: A lifeline for peripheral patients

Dr Irfan Bhat, a cardiologist at the Super Specialty Hospital in Srinagar highlighted the role of the “Save Heart Initiative” in reducing mortality rates. The initiative enables doctors across Kashmir, including those in remote areas, to perform thrombolysis under the guidance of cardiologists, Dr Bhat being one of the founding members. According to Dr Bhat, the program has significantly improved survival rates, with 80 per cent of heart attack patients from peripheral areas now receiving thrombolysis before they are sent to Cath Labs.

Dr Bhat said similar trends as were documented by SKIMS Soura study were observed at Super Specialty Hospital too. On average, Kashmir’s two main tertiary care hospitals—SKIMS Soura and Super Specialty Hospital—receive 25 heart attack patients daily. He said at SSH Srinagar, 80 percent patients are now received after thrombolysis. Dr Bhat emphasised that while primary PCI remains the preferred treatment for STEMI, it is not the best option if it means losing the golden hour.

Implications for public awareness and healthcare policy

The study’s findings call for urgent measures to address treatment delays and raise awareness about recognising heart attack symptoms early. Greater awareness campaigns, these cardiologists believe, are essential to ensure people recognize symptoms and seek immediate medical help. Simultaneously, facilities in peripheral hospitals need to be enhanced to enable timely thrombolysis, and doctors in remote areas must be equipped and trained to administer thrombolysis effectively.