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Improving Cardiac Care: Integrating Community Outreach Program for Early Recognition and Rapid Response in Germany

Frank Breuckmann, Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen

Stephan Settelmeier, Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen

In-hospital clinical pathways of patients with acute chest pain address late-stage myocardial ischemia. Low symptom awareness results in relevant prehospital time delays. Certified US chest pain programs include community outreach as early heart attack care initiative. In contrast, German programs do not - but should - cover community outreach yet.

Introduction:

Early Heart Attack Care (EHAC) is a community outreach program that aims to improve the quality of prehospital care for patients experiencing chest pain or other symptoms of acute coronary syndromes (ACS).

Even though the implementation of the first chest pain centres significantly improved the level of in-hospital care in ACS, there was still a significant need for better education and outreach in the prehospital setting. Therefore, EHAC was established in the United States in 2012 and has since been successful in improving awareness, education, and engagement within the preclinical setting involving patients, relatives, bystanders, and emergency medical systems (EMSs).

In the clinical setting, patients suffering from chest pain are treated in specialized Chest Pain Units (CPU) with defined in-hospital clinical diagnostics, decisions, and treatment pathways. In Germany, the certification process is defined by criteria developed by the German Cardiac Society (GCS). As “time is muscle”, timely reperfusion of myocardial infarction is the main goal. In this case, prehospital time delay represents a major problem.

The importance of prehospital care for patients with ACS cannot be overemphasized. Time is of the essence in these cases, and every minute counts in saving lives. Prehospital delays in seeking medical attention and receiving appropriate treatment can result in irreversible myocardial damage, disability, or even death. Therefore, it is essential to improve education and outreach in the prehospital setting to ensure timely reperfusion, reduce prehospital time delays and integrate prehospital and hospital-based care providers. One of the main reasons why prehospital time delays occur is that patients often misinterpret symptoms and do not appreciate the need for urgent evaluation of acute ischaemic heart disease. Many people mistake the symptoms of a heart attack for indigestion, muscle pain, or other non-cardiac problems, leading to a delay in seeking medical attention.

EHAC aims to overcome this issue by providing education and outreach to help people recognize the signs and symptoms of a heart attack and encourage them to seek medical attention as soon as possible. The EHAC program is based on the idea of structured clinical pathway-based heart attack care but expands it from the hospital to the community. It aims to involve and train bystanders to increase the number of active, committed caregivers beyond the level of medical professionals. The program provides information about the symptoms of a heart attack and encourages people to place an emergency call as soon as they experience or recognize any of these symptoms. It also teaches people how to perform basic life support, including cardiopulmonary resuscitation, until EMSs arrive.

The EHAC program has been successful in the US, and there is growing interest in bringing this program to Europe. In Germany, a working group has recently been established to develop a similar program tailored to the needs of the German population. This program will include an online teaching platform with certification abilities for widespread training of non-professional caregivers. The German Heart Foundation, the country's largest patient organization, has already been involved in constructing a way for implementation of the program.

Acknowledging the increasing rates of self-referral of patients, the need for community-based interventions for heart attack care has become increasingly recognized in recent years. EHAC is one such program that aims to bridge the gap between hospital-based care and the community. The program provides education and training to bystanders, enabling them to recognize the symptoms of a heart attack and take appropriate action. This, in turn, leads to a reduction in prehospital time delays and an increase in the number of patients who receive timely reperfusion.

In conclusion, the development of standardized CPUs has significantly improved in-hospital care for patients with ACS. However, there is still a need for better education and outreach in the prehospital setting. EHAC program, a successful community outreach program in the US, has the potential to fill this gap. With continued efforts to improve prehospital care for patients with ACS, we can help more people receive the lifesaving care they need when they need it most. An EHAC program in Germany has the potential to make a significant impact in reducing morbidity and mortality from heart disease, and we should continue to invest in these efforts. Therefore, the EHAC concept must also become a baseline element for CPU certification.

References:

1. Bahr, R., T. Rassaf, and F. Breuckmann, Community Outreach in Terms of Early Heart Attack Care as a New Way of Thinking in Chest Pain Center/Unit Care Giving-Commentary on the German Chest Pain Unit Network. Crit Pathw Cardiol, 2017. 16(4): p. 167-168.
2. Breuckmann, F., et al., Chest Pain Centers: A Comparison of Accreditation Programs in Germany and the United States. Crit Pathw Cardiol, 2015. 14(2): p. 67-73.
3. Breuckmann, F. and T. Rassaf, Acceptance of the Chest Pain Unit Certification Process: Current Status in Germany. Crit Pathw Cardiol, 2018. 17(4): p. 212-214.
4. Breuckmann, F. and T. Rassaf, Early heart attack care as a prehospital programme designed to supplement the established chest pain unit concept in Germany. Eur Heart J Acute Cardiovasc Care, 2020. 9(1_suppl): p. 93-94.
5. Breuckmann, F., et al., German chest pain unit registry: data review after the first decade of certification. Herz, 2021. 46(Suppl 1): p. 24-32.
6. Breuckmann, F., et al., Survey of clinical practice pattern in Germany's certified chest pain units: Adherence to the European Society of Cardiology guidelines on non-ST-segment elevation acute coronary syndrome. Herz, 2022. 47(6): p. 543-552.
7. Claeys, M.J., et al., Editor's Choice-The organization of chest pain units: Position statement of the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care, 2017. 6(3): p. 203-211.
8. Giannitsis, E., et al., Kriterien der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung für „Chest Pain Units“. Der Kardiologe, 2020. 14(6): p. 466-479.
9. Settelmeier, S., et al., Management of Pulmonary Embolism: Results from the German Chest Pain Unit Registry. Cardiology, 2021. 146(3): p. 304-310.

Frank Breuckmann

Frank Breuckmann is heading the working group “acute chest pain” of the German Cardiac Society and was significantly involved in introducing the certification process of German Chest Pain Units. Together with Stephan Settelmeier, they are now taking care of additional implementation of an early heart attack care program in Germany.

Stephan Settelmeier

Stephan Settelmeier is member of the working group “acute chest pain” of the German Cardiac Society and performing clinical health care research on German Chest Pain Units. Together with Frank Breuckmann, they are taking care of additional implementation of an early heart attack care program in Germany.

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