Heart disease
“The ‘call-to-balloon’ time for higher risk STEMI heart attack patients in England, Wales and Northern Ireland has risen by 28 per cent.” Darzi review
How can we help these patients?
When I was young, the important target was the “door to needle” time. Things have moved on and now it is “call to balloon”. What both targets have in common is that they are about getting treatment to patients with a heart attack without delay.
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Unfortunately, we are going in the wrong direction.
So how can we help? Here are some tips from BMJ Best Practice Comorbidities on how to manage a patient with myocardial infarction and diabetes • Monitor blood glucose closely in your patient with acute coronary syndrome • Keep blood glucose <11 mmol/L while avoiding hypoglycaemia • Do not routinely use a variable rate intravenous insulin infusion but consider it if a target blood glucose <11 mmol/L is not achieved • Refer patients with ACS and diabetes early to the diabetes in-hospital specialist team or available experts in diabetes management. • Check baseline kidney function as you would on admission for any acutely ill patient and monitor particularly closely if your patient has a history of CKD, diabetes, and/or heart failure. • Be aware that certain medications (such as some beta-blockers and thiazides) may be associated with hyperglycaemia and may need to be reviewed • Check the patient’s feet.
• According to Lord Darzi, “the ‘call-to- balloon’ time for higher risk STEMI heart attack patients in England, Wales and Northern Ireland has risen by 28 per cent.” • There is a lot to this sentence. One of the key phrases is high risk. And one of the things that makes people high risk is comorbidities.
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