World Follows, As PGI Shows The Management Way; Reduced Mortality, Cost Effective

The department of Cardiology at the Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh has claimed that the comprehensive management protocols evolved over years by it had helped significantly reduce the high mortality among patients of acute coronary syndrome (ACS – decreased blood flow in the coronary arteries) and cardiogenic shock (SHOCK – inability of a weakened heart to pump sufficient blood)

This approach to patient care, resulting in improved patient outcomes, has been appreciated by various visiting international faculty from some of the renowned cardiology institutes of the world, including Cedars-Sinai Medical Center and Mayo Clinic, USA, and is being followed in their respective hospitals, Dr. Yash Paul Sharma, Professor and Head of the Department, shared with media persons during an interaction on Monday.

Photo By : Life In Chandigarh

He also mentioned that the department’s protocol of gradually stenting the blocked arteries, if necessary, taking the most blocked artery first, instead of all blocked arteries together, was also finding increasing support the world over after initially being largely ignored. This way the stress on the weakened heart gets reduced, he emphasised.

Dr Sharma informed that “From 2003 onwards we have been presenting our data and evidence in medical literature nationally and internationally. A planned research with ethical clearance was started from 2007 onwards to see the trend of cardiogenic shock and acute coronary syndromes.”

He said the research showed that initially the mortality in the overall acute coronary syndrome population was around 16% till 2012, which has gradually reduced to current level of 6 to 7%. Among patients with cardiogenic shock, the mortality was as high as 36% to 40%, which had reduced to around 30% during 2018 – 2019. In patients with severe mitral regurgitation, characterised by abnormal reversal of blood flow from the left ventricle of the heart to the left atrium, the mortality was initially around 55%, which has reduced to current level of around 40%, he added.

Dr Sharma observed that despite significant improvement in outcomes of patients with acute coronary syndrome, its overall incidence had increased substantially due to a multitude of factors, but mortality among patients with cardiogenic shock continues to remain as high as 40-60% even in the developed countries.

Spelling out the department’s plans to share its knowledge and expertise with other hospitals, he said “Our aim is to achieve lower mortality world-wide by using well monitored, innovative and integrated approaches in high risk groups of acute coronary syndromes using cost effective approaches. For this we have already started a multi-centric national Registry for patients with acute coronary syndrome and cardiogenic shock. Through this Registry we will be sharing our experience and guiding other centers across India to achieve lower mortality at low cost in patients with acute coronary syndrome,” he added.

Dr Sharma was accompanied by a couple of members from his team, namely Dr Himanshu Gupta and Dr Prashant Panda and senior residents Dr Sabari Krishnan and Dr Santosh Kumar.

Guidelines For Maintaining Healthy Heart

* Ensure regular activity, at least 150 minutes of weekly exercise of moderate intensity (try to distribute over 5 days)

* Indulge in meditation, or yoga, or both as stress busters

* Diet : Reduce intake of sugary products like sweets, soft drinks, other sweetened beverages; increase intake of whole foods like fresh fruits, vegetables and whole grains; consume good quality high protein diet like plant-based protein for vegs and non- frozen fish and non- red meat (poultry) products, egg white for non-vegs

* Maintain normal Haemoglobin for better outcomes

* Avoid re-using oil multiple times and reduce overall oil consumption

* Reduce salt intake to reduce your blood pressure and heart failure symptoms (Reducing blood pressure will decrease future occurrence of cardiovascular events; although different groups of patients will have different optimum levels of blood pressure. Ask your physician for your optimum level.

* Control blood sugars, optimal is to maintain HbA₁C around 7%; Low blood sugar level is more dangerous than mildly high blood sugars.

* Avoid smoking absolutely; if you can’t stop completely at one go, start by reducing day by day; remember second hand smoking (or passive smoking) is as bad as direct smoking, so persuade your friends and family to stop smoking; ask your physician for any pharmacological support to maintain smoking cessation

* Avoid alcohol intake.

* Don’t skip your prescribed drugs; some of the them are highly essential and even missing few doses matters a lot for drugs like anti-platelets, beta- blockers and angiotensin converting enzyme inhibitors (keep extra tablets of these with you all the time and if you miss them at your usual time, take them when you remember)

* Keep your weight under check; it is not only good for heart, but also reduces blood pressure, increases burden of blood sugars, reduces orthopaedic problems

* Have a good night sleep, recommended is between 6 and 9 hours

* All of these activities may be difficult initially; take one step at a time, keep encouraging your peers to join you.

* In case you have chest pain take tab Aspirin 325 mg and tab Ticagrelor 90 mg two tablets stat along with PPI like Pantaprazole /Ranitidine. Typical pain is in the middle of the chest and radiates to the arm and accompanied with sweating. If this type of pain occurs, these tablets should be taken. If in doubt only Aspirin 325 mg can be taken.

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