In its first assessment of the State’s flagship scheme “Idhayam Kappom”, the Directorate of Public Health (DPH) and Preventive Medicine has found that administering cardiac loading doses to patients coming with symptoms of Acute Coronary Syndrome to Primary Health Centres (PHC) and Health Sub Centres (HSC) before referring them to higher centres was effective in improving the survival rates of patients, especially those who reached a higher facility within an hour.
The State government launched ‘Idhayam Kappom Thittam’, an initiative to provide cardiac loading doses (aspirin, clopidogrel and atorvastatin) at PHCs/HSCs to prevent deaths due to cardiac illness, on June 27, 2023.
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To evaluate the outcomes of patients who presented with chest pain and received cardiac loading dose at the primary care setting, doctors of Karpaga Vinayaga Institute of Medical Sciences and Research Centre and DPH, took up secondary data analysis of 6,493 patients covered under the scheme from its launch to August 2024. The findings were published in an article — “A cross-sectional study on the clinical profile of patients with symptoms of acute coronary syndrome (ACS) who received loading dose at primary care facilities under Idhayam Kappom Thittam Scheme in Tamil Nadu” — in the latest edition of the Tamil Nadu Journal of Public Health and Medical Research.
One of the authors, T.S. Selvavinayagam, Director of Public Health and Preventive Medicine, said this was a preliminary analysis and they planned to follow-up on the outcomes of interventions in the future.
Demographics data of the study population showed that most of the patients were men (4,248 persons). Almost half of the study population were aged 45 to 60 years (2,137 men and 1,148 women).
Symptoms-wise, 76.5% (4,964) of the persons reported to the primary care facilities with chest pain. This was followed by palpitations in 10.9% and pain radiating to the neck/jaw/arm/shoulder in 6.6% of the patients.
Once a patient reports to a PHC/HSC with symptoms of ACS, he/she will be referred for ECG followed by a telephonic consultation with the district nodal cardiologist. Following this, emergency cardiac loading dose is given and the patient referred to secondary/tertiary care facilities for further management.
The analysis found that at the higher centres, 90% of patients (5,846) were diagnosed with myocardial infarction, while 10% (647) had gastritis. Evaluating the outcomes, the authors found that 97.7% of the patients (6,346) were alive and stable, while 2.2% (143) died and 0.1% (4) died during transit.
Co-morbidities
Of the study population, 43.6% had hypertension and 21.5% had diabetes. It found that patients who had diabetes had a mortality of 3.2% as against those who without diabetes (1.9%). Those who had diabetes for more than 10 years had a mortality of 12.5%, while those who had diabetes for less than a year had a mortality of 1.8%. A previous history of coronary artery disease (CAD) was associated with a considerably higher mortality of 6.4% compared to those who did not have a previous history of CAD, whose mortality rate was two per cent.
A critical factor observed was the time taken to reach the referral facility — those who reached within 60 minutes (of acute chest pain) had a better survival rate than those delayed by more than 60 minutes with a mortality rate of 6.1%, the study said. It drew attention to the “golden hour” in managing acute myocardial infarction. The average time taken for the cardiac loading dose was 13.09 minutes and that taken to transfer patients to a secondary/tertiary care centre was 46.25 minutes.
The authors said the study affirmed the effectiveness of early cardiac intervention at primary care centres under the scheme.
Published – January 23, 2025 02:53 am IST