“There are clear deficiencies in our health care system. It fails the test of providing universal coverage but beyond that, the major problem is the extremely high cost. It is cost ineffective—prohibitively so. I personally attribute much of this enormous expense to waste, fraud, and to the unchecked cost of drugs and medical devices.”
It was this statement in the manuscript of heart surgeon Dr. Sameer Mehta that made me stop. He was obviously angry about what had happened to his life-long profession. So, when he made a plea to restore the capability of treating heart attacks here in the West Village, I read very very carefully.
By Sameer Mehta, MD
With the closing of the 161-year-old icon, St. Vincent’s Hospital in Greenwich Village, in 2010, residents wonder whether the West Village is a safe place to live in case of emergencies, such as a heart attack.
Some residents who have read my book, Preparing for a Heart Attack – and Surviving It, have sought my comments on this critical issue. Having addressed epidemiological and logistical factors relating to heart attacks in numerous countries (The Lumen Foundation, dedicated to saving lives from heart attacks, has assisted 27 countries in education, research, and training for the management of heart attacks), I will endeavor to provide scientific guidance for combating a scenario of limited resources for urgent heart attack treatment. In doing so, I want to also mention that the treatment of strokes parallels that of heart attacks; both require similar logistical planning.
Regarding a logistical approach for heart attack management, it is imperative to recognize the massive population density in Lower Manhattan. Published reports indicate a resident population of about 800,000 that increases almost four-fold due to massive visitor influx. The alarming fact is that there is now one hospital remaining in an area with a daily population greater than the entire city of Boston. If you also factor in the impenetrable traffic, then urgent mobilization for a heart attack victim becomes a most perilous matter.
The quintessence of saving lives from heart attacks is that every minute counts. This urgency is captured by the term “Door to Balloon Time” (d2b) that has been established by the American Heart Association. It computes the time from the patient’s arrival at the hospital to the opening of the occluded artery through an angioplasty. The shorter the d2b, the better the outcomes. Clearly, dense traffic and/or limited access to a skilled angioplasty facility may delay d2b.
So how does one address this challenging situation? Clearly, the answer lies in establishing a reliable urgent care facility for exigent heart attacks and stroke care. Although a freestanding facility for invasive cardiology procedures is possible, a better long-term solution is to house it in a larger hospital that can fill the vacuum created by the shutting of St. Vincent’s. The vulnerable residents of Lower Manhattan, in particular the elderly, deserve a state-of-the-art facility that can treat these life-threatening situations. Towards this goal, the community is already assembling a powerful and dedicated group of stakeholders, to whom I add this scientific rejoinder.
Another important step can be taken in the interim: Residents must objectively evaluate if they are at risk for a heart attack. Remember that women have atypical symptoms, diabetics have no symptoms, and the elderly have confusing symptoms. Recognize the heart attack, call 911, and chew an aspirin. A d2b is of no value if you dither in these basic decisions to beckon help. The community can also involve the local EMS. The objective is to formulate an unambiguous path to transport a heart attack patient to the nearest skilled facility where the amazing angioplasty procedure can rapidly save a life.
Dr. Sameer Mehta is Chairperson of The Lumen Foundation, the Course Director of the largest heart attack-related meeting in the world, and the author of six textbooks. He is also Past President of the American Heart Association in South Florida.