The HeartRescue Global Project

Speeding the time to treatment for severe heart attacks

The Medtronic Foundation

In the wake of a severe heart attack, also known as an ST-elevation myocardial infarction (STEMI), receiving effective treatment within several hours is crucial to reduce muscle damage and the risk of death. Effective treatment requires reperfusion (opening the blocked artery) using either thrombolytic medications or a more expensive (and more effective) percutaneous coronary intervention (PCI) performed in a cardiac catheterization laboratory. Given the need for rapid treatment, a few factors can mean the difference between life, death, and long-term disability.

While STEMI is a serious problem in high-income countries such as the United States, it has been an increasingly visible issue in low- and middle-income countries (LMICs) such as India, China and Brazil. People in these countries are now living long enough, thanks to advances in fighting infectious disease, to fall victim to chronic noncommunicable diseases like cardiovascular disease (CVD) and “first-world” medical crises like STEMI. In many LMICs, the infrastructure to treat STEMIs with thrombolytics or PCI in a timely manner simply doesn’t exist or is woefully inadequate, further increasing mortality rates.

In 2014, we were contracted by the Medtronic Foundation to implement HeartRescue Global, an extension of an already existing HeartRescue program in the United States, in selected cities in China, India, and Brazil. The goal of HeartRescue is to create an effective STEMI response program, geared to the unique needs of the local community, that speeds time to effective treatment and improves access to quality health care—in other words, to ensure that all of the medical and EMS infrastructure is on hand to enable effective reperfusion treatment and increase STEMI survival rates.

Vitória da Conquista, Brazil, serves as an important regional center for health care, including several smaller cities in its surrounding region of Bahia and Minas Gerais. Our program here is less advanced than in Suzhou or Bangalore; we originally had planned a HeartRescue effort in Sao Paolo, which was discontinued. As an example of the challenges, Vitoria da Conquista faces, the only publicly funded reperfusion strategy currently available for STEMI patients in the public health care system is through thrombolytic medications in the General Hospital—that is when thrombolytic drugs are available.

We believe that the development of a multi-faceted intervention in Vitória da Conquista, including the community, EMS, and public and private hospitals, along with expanding access to thrombolytic medications and privately funded PCI services, will enable improvements in care for STEMI patients. As in China and India, we are developing a systematic STEMI patient registry data-collection system that focuses on the quality measures standardized for the HeartRescue Global program, which will enable tracking of patient access, reducing time to effective reperfusion treatment, and continuous quality improvement of STEMI interventions.

With heart disease being the number one leading cause of death of women, educating all members of the community- from high school aged youth to elderly adults can improve interventions and awareness of this deadly issue. By having quick and open pathways of communication once marginalized persons reach the hospital, effective action can be taken to save lives.