CCF Cardiologist and Researchers: Bridging the Healthcare Divide

By Sharon Lewis

Heart disease is the number one cause of death around the world. Typically, people on the lower rungs of society do not fare well medically or socially. They suffer disproportionately from uncontrolled risk factors such as diabetes, obesity, increased alcohol consumption, and stroke, resulting from sedentary lifestyles and the lack of quality medical care.

In 2014 Cleveland Clinic Foundation (CCF) Cardiologists and Researchers came together to design a protocol that they hoped would decrease the ST-Elevation Myocardial Infarction (STEMI) mortality rate. In plain language, the STEMI is a severe heart attack “caused by a sudden and prolonged blockage of the blood supply to the heart and a primary cause of death in patients with heart disease.” During a STEMI, the heart muscle is dying from blocked coronary arteries (lack of blood flow). Their goal is to standardize a protocol that could decrease health care variability and save lives regardless of zip code.

On November 15, 2021, their study titled, Relationship of Neighborhood Deprivation and Outcomes of a Comprehensive ST-Elevation Myocardial Infarction Protocol, authored by Chetan P. Huded, Jarrod E, Dalton, Anirudh Kumar, Nikolas I. Kreiger, Nicholas Kassis, Michael Phelan, Kathleen Kravitz, Grant W. Reed, Amar Krishnaswamy, Samir Kapadia, and Umesh Khot, was published in the Journal of the American Heart Association.

The STEMI protocol was activated in every CCF Emergency Room in Northeast Ohio. “The study population included 1,761 patients, 71% of which were from low-socioeconomic communities.” The study was a comparison of pre-and-post protocol outcomes. “The rate of in-hospital death among patients residing in low socioeconomic neighborhoods decreased by over 50% after the implementation of the protocol.” The goal of the protocol is to reduce the time it takes to get a person to the cardiac catheterization lab where blocked arteries are opened to restore blood flow to the heart muscle. Doctors call it reducing “door to balloon time.”

When asked if they had any idea that the study would prove to be so statically relevant when they started, Dr. Umesh Khot, head of Regional Cardiovascular Medicine at Cleveland Clinic and senior author of the study responded, “No, not really. We hoped to make an impact, but we did not know it would be as substantial. When we first started on this journey over five years ago, we knew that it (death from heart disease) was an issue both nationally and locally, and we wanted to see if, as a healthcare system, we could improve the care of our most vulnerable patients at their most vulnerable time, such as during a heart attack. We sought to transform the care of these patients by eliminating care variability so that all patients received the highest standard of care every time.”

If you think you are having a heart attack, you should get to the hospital as quickly as possible. An EKG will determine if you are having a STEMI. Then the protocol goes into effect. Dr. Khot walked me through the process.

Step 1: Standardized emergency department cardiac catheterization lab activation criteria. Step 1 involves all necessary testing, blood work, and stabilizing the patient in preparation for the cardiac catheterization.
Step 2: Employ the safe handoff checklist. Following the plan standardizes the necessary steps/procedures to safely transport the patient to the cardiac catheterization lab.
Step 3: Immediate transfer to a cardiac catheterization lab. Immediate catheterization is the most crucial step. Getting the procedure soon after admittance to the ER is key to survival.
Step 4: Performing the catheterization. “Using the radial artery in the wrist as the first option for access to the heart’s arteries. This approach has proven to have fewer bleeding complications and improved survival than using the femoral artery” (at the groin).

Chairman of Cardiovascular Medicine at CCF, Samir Kapadia, M.D., added, “This is the first (study) to show how a healthcare organization can transform heart attack care and improve survival in patients no matter what neighborhood they live in. We believe this protocol, which focuses on reducing care variability, can be a model for other organizations working to improve the equity of their care system.”

With the reported success of this heart attack protocol and publication of the study, other hospitals are reaching out to CCF for information so they can implement the protocol and improve the outcomes for their patients and communities. CCF has brought excellence in healthcare to Northeast Ohio for the last one hundred years and no doubt will continue.