Although the steady rhythm of a heartbeat can be taken for granted, it’s comforting to know there are teams of researchers and clinicians working together around the clock to make sure patients get the most advanced care fast when it's needed in an emergency.
Wake Forest University School of Medicine researchers created a revolutionary clinical protocol and decision support platform that uses objective data to identify levels of risk in patients who come to the emergency room with chest pain. The HEART Pathway protocol was designed to enhance clinical decision-making about which chest pain patients need advanced diagnostic procedures, such as angiography and stress testing, and which can be safely sent home without those costly, time-consuming and frequently unnecessary measures.
“Figuring out how we best deliver care for patients with chest pain is a high priority,” said Dr. Chad Miller, Atrium Health service line leader for emergency medicine and chair of emergency medicine for the School of Medicine. “Without having a community of scientists in a learning health environment, this work couldn’t have been done.”
HEART Pathway: Leading in Discovery and Improved Care FOR ALL
HEART Pathway was developed by a team led by Dr. Simon Mahler, professor and vice chair of research in emergency medicine at the School of Medicine. The team set out to build a solution that would integrate into the electronic health record with HEART Pathway plug-ins that are available for quick activation on America’s top electronic medical platforms, including Epic, Cerner and Apple iOS.
“As we implement the HEART Pathway protocol into our electronic systems, we are less likely to miss a patient that’s having a heart attack.”
Since its release, the protocol has been adopted by all of the hospitals in the Atrium Health Wake Forest Baptist system and is seeing increased acceptance in emergency departments nationwide.
Getting Heart Patients to the Right Care at the Right Time
“The whole point of an academic learning health system is that we are studying data so we can improve patient care and we are doing it in a quick manner,” said Mahler.
The next phase will take the concepts of the HEART Pathway and fit them to the pre-hospital model to improve triage of patients by paramedics when they are first evaluating chest pain patients. A recent study showed that paramedics were able to effectively risk-stratify patients using the new protocol.
For instance, the HEART Pathway formula, along with the assistance of telehealth services, recently assisted Wilkes County EMS in ensuring that a 77-year-old patient experiencing a heart attack caused by a gastrointestinal bleed was transported directly to Atrium Health Wake Forest Baptist Medical Center instead of the closer-to-home Atrium Health Wake Forest Baptist Wilkes Medical Center. The new protocol helped this patient receive rapid specialty care and prevented an inevitable and unnecessary transfer – getting the lifesaving care they needed faster without incurring additional costs and pain.
Paramedics have been trained to look for something called a STEMI [ST-segment elevation myocardial infarction] — known to many people as the widow-maker heart attack where the patient has to go immediately into surgery. But these type of life-threatening heart attacks are present in only 7% of patients with chest pain transported to the hospital by EMS.
What are the Signs of a Heart Attack?
According to the American Heart Association, it’s crucial to catch the signs of a heart attack early. Some heart attacks are sudden and intense, but most start slowly, with mild pain or discomfort. Know the signs and call 911 if experiencing any of these heart attack warning signs:
- Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes – or it may go away and then return. It can feel like uncomfortable pressure, squeezing, fullness or pain.
- Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
- Shortness of breath. This can occur with or without chest discomfort.
- Other signs. Other possible signs include breaking out in a cold sweat, nausea or lightheadedness.
For many reasons, it’s best to call 911 so that an experienced EMS team can begin treatment and arrange rapid transport to the emergency room if needed.
Changing the World of Chest Pain
“If we can apply the HEART Pathway protocol in an EMS setting, we can get that patient to the right place at the right time,” said Mahler. “For example, a high-risk patient transported to a small community hospital may need to be transferred eventually to a hospital with specialized cardiology services. If we can get them directly to the best location for their care initially, we can avoid delays and need for additional transfers.”“If we can figure out ways to improve care and help advance emergency medicine care practices we’re going to change the way the entire country, and hopefully the world, takes care of patients with chest pain,” adds Mahler.
If you have an increased risk of heart issues or it has been more than a year since your last primary care appointment, schedule a visit at one of our locations across the Piedmont Triad and greater Charlotte regions in North Carolina and the northwest, central and south regions of Georgia.
