Why Goa is the best place to be when there is a heart emergency

Data presented at Goa's National Cardiovascular Summit showed severe heart attacks can be identified and stabilised within 19 minutes in the state. The figures point to faster diagnosis, quicker thrombolysis and lower in-hospital deaths under Goa's STEMI care model.

In Short

• Goa adopted the STEMI hub-and-spoke model in 2019 before other states
• Primary health centres use AI-powered ECGs with real-time specialist review.
• Doctors at lower centres are trained to give thrombolysis before coronary angioplasty

A patient in India who suffers a severe heart attack due to a blocked coronary artery has the best chances of receiving fast, life-saving treatment in Goa, compared with anywhere else in the country.

Crucial data presented at the National Cardiovascular Summit, organised by the Goa government and Tricog, a health-tech company that provides artificial intelligence (AI)-powered ECG solutions last week, showed that serious heart attacks are being identified and patients stabilised within 19 minutes of reporting at any public healthcare facility in the coastal state.

The technology can flag serious heart attacks within minutes, even at primary health centres.

Patients, after thrombolysis – administration of a drug that helps dissolve dangerous blood clots before further treatment – are then referred to higher centres for definitive care.

Goa was the first state in the country to implement the hub-and-spoke model for STEMI (ST-elevation myocardial infarction), a severe, life-threatening type of heart attack caused by the complete blockage of a coronary artery, in 2019.

This was eight years after the Union health ministry released guidelines for nationwide adoption of the model to save lives.

The need for such a system is underscored by the burden of cardiovascular disease in India.

Cardiovascular diseases claim 25–28 lakh lives every year, the highest due to a condition, accounting for roughly 25–27% of all deaths in the country. India also sees about 5,760 heart attacks every day – roughly four every minute.

Nearly 50% of these heart attacks are estimated to occur in people under 60 years of age, while roughly one in four heart attacks is fatal.

Thousands of lives are therefore lost to cardiovascular disease every day, primarily because patients either do not seek treatment in time or, even when they reach a healthcare facility, do not have access to the emergency care they need.

With the country having only about 50,000–60,000 cardiologists and just around 6,000 interventional cardiologists, the government has pushed for a hub-and-spoke model to reduce deaths from cardiac emergencies.

So far, seven states , some of them partially, have implemented the model. The figures presented at the summit suggest that Goa is doing particularly well in ensuring continuity of care, enabling prompt treatment and potentially saving lives.

HOW THE MODEL WORKS

India’s STEMI model is a decentralised system of care developed in 2011 by STEMI India, by the Indian Council of Medical Research (ICMR) under the health ministry in collaboration with the Cardiological Society of India (CSI) and the Association of Physicians of India (API), to tackle the high mortality associated with STEMI across the country’s diverse healthcare landscape.

The key to its implementation was the creation of a seamlessly integrated, three-tiered system enabled by a digital hub-and-spoke network.

The aim was to ensure that every patient, whether in a remote village or a bustling city, receives appropriate, time-critical treatment.

Under the model, a patient reporting chest pain, heaviness or breathlessness, even at a primary health centre, can undergo an AI-powered ECG.

The ECG is read by specialists at Tricog in real time 24 X7, and a report is sent back to the duty doctor within minutes.

According to Dr Charit Bhograj, cardiologist and co-founder and CEO of Tricog – a Bengaluru-based company set up in 2009, since the first rollout of the model, the time taken to detect a heart attack has come down to under eight minutes.

This is critical because with every minute of delay in treatment in a STEMI case, the risk of death increases by 7%. Quick diagnosis and timely follow-up treatment can therefore make a difference between life and death.

As part of the model, duty doctors at lower-level centres, who are typically MBBS doctors rather than cardiologists, are trained to administer thrombolysis – a life-saving intervention that can be given before percutaneous coronary intervention (PCI), or coronary angioplasty, is performed at a higher centre, usually a tertiary-care hospital.

THE GOA STORY

Vishwajit Rane, health minister in the Goa government, told India Today that the state adopted the STEMI model ahead of others as part of its effort to ensure access to timely cardiac care across every health facility.

“My father (former Goa chief minister Pratapsingh Rane) had a heart attack years ago, and we could get timely treatment just because of the privileges we had. But the aim of our government has been to ensure that level of service and healthcare delivery for everyone living in Goa,” he said.

The project in Goa started with Goa Medical College and Hospital as the hub and 12 primary health centres as spokes. It was later expanded to 20 PHCs by 2021.

So far, 461,427 cases have been diagnosed, with 11,640 identified as critical patients in the state that has three administrative districts.

Data presented at the summit in Goa last week showed that a patient with a heart attack in the state reaches a hospital within an average of 2 hours and 11 minutes, while the national average can be as high as 4.5-13 hours.

Thereafter, an ECG typically confirms the diagnosis within 12 minutes, while thrombolysis, in cases where it is required, is administered within 19 minutes. Patients are then referred to tertiary-care centres for PCI.

The figures also showed that in-hospital deaths due to acute heart attacks have dropped from 7.2% in 2019 to 1% now in the state.

The model is now also being implemented in Maharashtra, Karnataka, Telangana, Odisha, Bihar and Manipur as well – already showing remarkable improvement in saving lives and is likely to be adopted in other states in the coming years.

“We have screened about 40 million people for heart issues so far and the aim is to cover 100 million – nobody should die because their heart attack was not diagnosed and treated in time,” said Dr Bhograj.

According to Dr C M Manjunath, a cardiologist who represents Bengaluru Rural in the Lok Sabha, there are gaps in the system that need to be acknowledged and addressed. However, full-fledged implementation of the model across states could be crucial in reducing deaths due to heart attacks in the country.

Dr Bhograj noted that detecting a heart emergency at a primary health facility using powerful technology was one thing, but ultimately states that are better placed to provide the follow-up care at the earliest will be able to protect more lives.

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