Tamil Nadu’s Idhayam Kappom initiative — a preventive heart health scheme rolled out by the State government — has completed six months and covered over 5,000 beneficiaries.
While an assessment of the scheme, which has made available emergency loading doses at the primary healthcare level to prevent deaths due to heart attacks, will be taken up at the end of the first year, cardiologists in the government and private sectors weigh the pros and cons of the initiative that has evoked a mixed response among a section of them.
As of last week, 5,145 of 5,827 persons who had visited Primary Health Centres (PHCs) with symptoms/suspected myocardial infarctions and 386 of 544 patients who went to Health Sub Centres (HSCs) have received the emergency loading dose since the scheme was launched in June 2023.
Director of Public Health T.S. Selvavinayagam said the aim of providing the loading dose (a set of drugs) was to reduce morbidity and mortality. “Evidence shows that there is a good impact if the loading dose is given to a symptomatic patient within an hour. The objective is to save lives in remote/difficult-to-reach areas, especially during transit,” he said.
A PHC or HSC is the easiest and quickest to reach for many, he said, adding: “If a person has symptoms, a clinical examination and assessment is done during which his/her vital parameters are checked and certain basic symptoms, such as chest pain/discomfort, pain radiating to the left side, breathlessness, abdominal discomfort and palpitations, are looked at. ECG is taken at the PHC.”
A cardiologist is available on call and his/her opinion is obtained. “Only on the advice of the cardiologist is the loading dose given. Then, the patient is shifted to the nearest tertiary care centre in the 108 ambulance... As of now, the health facilities are doing a follow-up of individuals who received the loading dose to ascertain the outcomes, whether an angiogram or stenting or medical management was done at the tertiary care centre. At the end of the first year, we will do an overall assessment,” Dr. Selvavinayagam said.
A cross-section of cardiologists has different views on the subject. A senior cardiologist said this was a good programme as emergency loading dose for acute coronary syndrome (ACS) has shown that it can save 25 lives per 1,000 patients. “This is a huge benefit,” he said.
Another senior cardiologist was sceptical of the programme. “There is a staff nurse guided by a remote doctor at the primary health care level. What if a person has non-cardiac pain? He/she could develop complications if the emergency loading dose is given without proper evaluation. In such circumstances, it can turn harmful, even causing gastrointestinal bleeding,” he said.
Another specialist stressed the need to confirm that it is a cardiac-origin pain through ECG, ECHO or blood test (cardiac enzymes) and rule out that the patient is not already on medication. “There is evidence that a new patient with confirmed ACS will benefit from a loading dose. He/she should be loaded as early as possible. But we need to confirm that a person has an ongoing heart attack or impending heart attack. Unless this is confirmed, we should not start an emergency loading dose. Clinical presentation, ECG, blood test (enzyme) and ECHO cardiogram will confirm ACS. The Health Department can make use of telemedicine and transmit ECG to a cardiologist,” he said.
Noting that it was a good regimen if rightly diagnosed, another cardiologist reiterated the need for proper evaluation as a dissection or tear in the aorta could mimic a heart attack, and if taken up for an emergency surgery, it could lead to bleeding. “If the diagnosis is not clear, it is better to quickly move the patient to a nearby tertiary care centre,” the doctor said.
