Heartfelt with Dr Melissa Walton-ShirleyView all posts »
Primary PCI in Masschusetts: Guidelines writers, how long must the rest of us suffer?Nov 16, 2009 14:03 EST
Romans 5; 3-4: "Suffering produces endurance and endurance produces character and character produces hope."
Indeed there is still "hope" for all of waiting to move primary PCI without surgery on-site forward in this country after this presentation. The data demonstrated (once again) that "among patients undergoing PCI, outcomes were almost identical in non-surgery-on-site and SOS (surgery on-site) hospitals. You would have thought the NCDR data would have been enough to push us to the point of expanding this lifesaving opportunity all across the US. Instead we still wait while many suffer.
Felix Adler: "We stand, as it were, on the shore and see multitudes of our fellow beings struggling in the water, stretching forth their arms, sinking, drowning, and we are powerless to assist them."
It's no secret that I champion the cause of the lytic noneligible. I've related to many the untimely death of my uncle after I administered lytic therapy for a noncomplicated inferior wall MI around 10 years ago. That death was completely unnecessary and totally preventable. Had he lived just 70 miles south in the state of Tennessee, where PCI without SOS had been practiced for 12 years, he would have undergone a primary PCI and gone home in a couple of days. Instead, he resided in Kentucky where for six years we've battled to move primary PCI forward, and we are still battling.
We learned last month that the governor has unwittingly tied the primary-PCI program to the state health-plan amendment that will require a vote on an expensive pediatric psychiatry facility bill that will likely fail because it is viewed as unaffordable. This move will cost thousands of lives and dollars by producing yet another delay in expanding this life saving program to the other eight hospitals that stand ready, willing, but disallowed to perform this procedure.
Fritz Williams: "Suffering and joy teach us, if we allow them, how to make the leap of empathy, which transports us into the soul and heart of another person. In those transparent moments we know other people's joy and sorrows and we care about their concerns as if they were our own."
Dr Guyton, chief of cardiothoracic surgery at Emory, the discussant for the Massachusetts trial, gave a fair and very human response to this data. He said, "If I'm in an ambulance and am asked if I want to go to a hospital without surgery on-site or a surgery hospital, I'm going to go to a surgery hospital. But if I'm in a nonsurgery hospital and need a PCI, I'm going to stay at that hospital." He's a surgeon but he "gets it," and he "gets it" far better than some of our very own guidelines writers who are cardiologists. I guess it's difficult to feel hunger when your mouth is full and for some, very difficult to feel pain when those who are suffering are not your own.
Marcel Proust: "We are healed of a suffering only by experiencing it to the full."
I write of our trials and tribulations in the world of intervention or--lack thereof--"in order to draw attention to the need. Our efforts have resulted in marginal results at best but with the aid of results like those from the NRMI registry, combined with the NCDR data, we know that we will eventually prevail, but not until many more suffer and die from lack of access to primary PCI. We also know that the onus is on us to improve our adherence to guidelines and continue to improve our rates of revascularization as evidenced by this registry information. These are small but not insignificant issues when it comes to the race against the 90-minute clock that runs on every single patient with STs up.
George Eliot: "Deep unspeakable suffering may well be called a baptism, a regeneration, the initiation of a new state."
Perhaps if everyone had to walk down that long hall from the ICU and tell their mother that her only sibling and last remaining first-degree relative had died a horrible and preventable death, it might result in a more enthusiastic endorsement of primary PCI without surgery onsite. I implore our guidelines writers to convene to make this a priority in our country. I ask them to publish guidelines that would lead to the mapping of our country to find the shortest point from ST-elevation to a primary PCI. I ask that they insist that this become a leading platform for healthcare reform that this country so desperately needs. Let us overcome the unnecessary suffering of STEMI patients all over these US who die acutely from lack of access to primary PCI or costly pump failure from untimely delivery of this lifesaving procedure.
Helen Keller: "The world is full of suffering. It is also full of overcoming it."