Why form a new society?


The reason for this new Society is described in its mission statement A society without walls whose primary purpose is to significantly reduce heart attack deaths". The Society seeks to develop in citizens a warlike mentality to win quickly the war against heart attack with what community hospitals now have at hand and apply this across the world. "Without walls" implies no turfdoms or constraints but a togetherness of cardiologists, emergency physicians, critical care nurses, etc. working on the same goals at the same time. The Society hopes to recreate another learning curve of progress very similar to that which took place in the 1960s with the development and universal application of the coronary care unit. It recognizes fully that science based medicine is at the very heart of this effort, but also understands that more is needed if modern treatment is to be applied optimally to the population at large. This sentiment was expressed in the Ansel Keys Lecture of the American Heart Association annual meeting (November, 1992) by Henry Blackburn, MD when he commented on two views of disease - the population and the individual view - on the thinking and activities in cardiovascular research, policy, and practice. He stated "I propose that the narrow focus on the individual accounts for most of the professional misunderstanding and public confusion about preventing cardiovascular and other chronic diseases." Contained in that article was the following quote:

"The Three Beauties: Bench, Clinical, and Population Research -

The Three Beauties of Biomedical Research. Gaze on them admiringly:

The Baroque Beauty of Biology

The Modern Beauty of the Clinic

The Classic Beauty of Epidemiology

Ponder their individual missions: The search for universal truths and specific mechanisms at the bench; for unique phenomena, their causes and cures in the clinic; and for mass phenomena, their causes and prevention in the population at large. Seek to preserve each, that all may flourish." Circulation 1992;86:1323-1331

Science based medicine is, metaphorically, like scoring in basketball......whether it be the soft outside three pointer or the slam dunk inside two pointer. However, progress can also take place while moving with the ball through assisting, and even without the ball, because the final results depend on team work of all of the players. Scoring is very much dependent on the delivery system. This also applies in medicine. Furthermore, science based medicine is not always available to handle completely each ordinary medical problem. Richard Horton, MD, editor of Lancet, coined the term "interpretive medicine" (interpretive cardiology) to fill this gap. In his words, " to interpret is to unify the practice and science of medicine".

So what is it that we lack in our efforts to score "big".......to take heart disease and heart attack deaths out of first place.......to win the war against heart disease?

1. We have to first declare war on heart disease and heart attack deaths. Then we need to use warlike strategy and mentality to accomplish this.
2. We need to have a definite game plan to win the war.
3. We need to believe in the plan with full commitment and dedication.
4. All for the greater good of society. Together we can make a difference.
5. We need to execute the game plan well.
6. We need the sustaining power and tenacity to hang in there.
7. We need to make the plan relatively simple so that it can be widely applied. (KISS principle).
8. We need to change our ways as we focus so as to target best the problem. At times we need to shock the present system.
9. We need to effectively communicate what we are doing and form partnerships with organizations that understand our ultimate goal.
10. We need to constantly re-examine what we are doing collectively in order to form consensus on to how to proceed (CQI).

GAME PLAN

The Strategy of Chest Pain Units in the War Against Heart Disease

1. Recreate the CCU learning curve and expand it to include the emergency department (chest pain center) and the community through awareness programs (specifically the EHAC program).
2. Prepare the emergency department with a comprehensive and systematic triage system for patients presenting with chest pain, and develop critical pathways to execute quality care that is cost effective and appropriate.
3. Develop chest pain providers as champions to the cause using the CQI process.
4. Integrate the chest pain center in the emergency department with the coronary care system, and unite the emergency physicians, cardiologists, and critical care nurses in early heart attack care....and thus shift the paradigm of heart attack care away from its being an emergency.
5. Promote in the community an awareness of early symptom recognition of a heart attack to include hospital outreach rehab programs, community educators, instructors in the workplace, CPR instructors, EMS personnel, etc.
6. Understand better the implications and improved benefits available through prodromal symptom recognition of a heart attack from information obtained through focus interviews with patients, cardiologists, and the public.
7. Unite the efforts of both the hospital's chest pain center with community awareness programs that will serve as the penetrating vehicle for community action (the community sarcomere).
8. Perfect the low probability ischemic disease work up so as to provide the machinery in the emergency department to sort out such patients and thus open the door to an increased number of patients in the community with suspected early ischemic heart disease.
9. Promote the science based evidence for optimal treatment of patients with ischemic heart disease utilizing the American Heart Association, ACC Guidelines and AHCPR.
10. Utilize hospital television educational television channels to broadcast short videos with the simple EHAC message to patients, families, and visitors on how to make use of this early recognition knowledge.......smoke before the fire.......pro-active rather than reactive.
11. Finally, promote and appreciate acute prevention as the earliest form of secondary prevention in that pre-hospital care becomes more important than post-hospital care.

Who then is the preferred heart patient?

We have no problems treating patients with cardiac arrest, pulmonary edema, cardiogenic shock, and even patients crashing with myocardial infarction. But our preferred "customer" is the patient..........

Seen early, when we can prevent death ---------> CPR not needed

Seen early, when we can prevent damage ---------> Heart damage prevented

Seen early, when we can open the vessel ---------> Ischemia prevented

Seen early, where we can use the chest pain center experience as a teaching opportunity to change behavior and improve the patient's lifestyle through primary risk factor prevention . Relate acute presentation to primary risk factor prevention.

Raymond D. Bahr, MD
President Emeritus