How Powerful is the Early Heart Attack Care Movement in the United States?

January 2013


This article was contributed by Dr. Raymond Bahr, Cardiologist & a founder of the Society of Cardiovascular Patient Care

How Powerful is the Early Heart Attack Care (EHAC) Movement in the United States? And the Answer is Very Powerful and this is based on "The Power of an Idea whose Time has come." It just makes Good Common Sense and is what is needed to save lives!

History of this Powerful Idea
In 1981, the First Chest Pain Center in the world was begun in the Emergency Room at St. Agnes Hospital in Baltimore, Maryland. It's purpose was to deliver Comprehensive Heart Attack Care to patients upon their arrival in the Emergency Room, but over time to Shift the Paradigm of Care to Early Detection in the Community and Early Treatment in the Emergency Room. This became known as EHAC Care or Early Heart Attack Care .
Over the next 10 years, this Type of Care was perfected at St.Agnes Hospital and in 1991 when a Grant was given to the Coronary Care Unit to deliver this EHAC message throughout the United States, it began to take growth in hospitals elsewhere as Chest Pain Emergency Rooms. Later, the name was changed to Chest Pain Centers in Emergency Departments. National Congresses were set up by St. Agnes to bring together Cardiologists, Emergency Nurses and Emergency Physicians interested in the further development of Chest Pain Centers through reporting on their own Centers.

In 1998, St. Agnes was able to Track more than 2000 Chest Pain Centers in ED that had been developed throughout the United States as a result of visiting the St. Agnes Chest Pain Center or finding out about such Centers at Exhibition Tables set up at the Annual Meetings of the American Heart Association, the American College of Cardiology and the American Society of Emergency Medicine. The Third National Congress of Chest Pain Centers took place at this time (1998) in Dearborn, Michigan and a very significant outcome was the decision to form a New Medical Society that would promote the further development of the Chest Pain Center Movement whose goal it would be to significantly reduce Heart Attack Deaths in the United States by placing more Emphasis on Early Heart Attack Care both in the Community as well as in the Hospital. It would do this by taking advantage of "An Idea whose Time has Come".

The Power of "An Idea whose Time has Come" was first seen in the Coronary Care Movement beginning in the early 1960s when the First Coronary Care Unit (CCU) was begun in a small Community Hospital in Bethany, Kansas and within 10 years, every Hospital in the United States (5000 hospitals) had such a Unit. Viral Growth (hockey stick growth) had taken place because the message was Powerful. It made good sense and patients benefited throughout.

The Growth of the 2000 Chest Pain Centers in ED was being propelled by such a Force as well. However, this came to a Standstill when the Health Care Finance Administration (HCFA) was about to issue a Ruling that Observational Services were not going to be reimbursed. Observation Units in Chest Pain Centers were vital in providing a mechanism for the Hospital to check out efficiently and safely patients with mild chest pain symptoms. This Ruling would have been devastating! The Society of Cardiovascular Patient Care opposed this and brought together many other Professional Groups in making the point that such Observational Services were vital to the Chest Pain Center's Efforts to reduce Heart Attack Deaths.

As a result of this effort, the HCFA decision was reversed. When this occurred , HCFA Administrators requested our Help in filtering out the Hospitals that had been using their Chest Pain Center Sign as a Marketing Tool only. It was at this point that the Society of Cardiovascular Patient Care started the Accreditation Process based on the Eight Key Elements of a Chest Pain Center that had been previously published in the American Journal of Cardiology. This Process of Improvement needed to be documented every three years (Cycles). The Society has now Accredited over 700 Chest Pain Centers throughout the United States and has as its goal to set up a Chest Pain Center in all 5000 Hospitals in the United States.

It is true that the power of "An Idea whose Time has come" resulted in the Successful Growth of both the Coronary Care Units as well as the First Chest Pain Center Movement, but neither of these had to pass inspection to develop. Once in place, the Care was left up to the Staff that managed these units. However, times have changed and more is expected. To ensure Quality Heart Attack Care, it has become necessary to set Standards in Performance. Accreditation has been adopted as a way to do this.

The Chest Pain Center Approach to the Heart Attack Problem is twofold. First, it attempts to spread to all 5000 Hospitals and their surrounding Communities with the message that "heart attacks have beginnings" and that such patients when detected early and come into the Hospital do much better. This amounts to Acute Prevention of the Heart Attack. It is Prevention that is taking place when the Heart Attack is Evolving. Stopping it in its track makes good sense and is Teachable. Since Denial here is usually present in the patient, there is real need for a Heart Care Giver. You can be Deputized into Action by taking this short Program at www.DeputyHeartAttack.org

Second, the Observation Unit of the Chest Pain Center evaluates patients with mild chest discomfort and only 15% are found to have an Acute Problem. The other 85% can be safely sent home in less than 24 hours of Observation. This Group has been shown to have Higher Risk Factors than the Public at Large. This is a Great Group to focus upon to reduce Risk Factors and Prevent Heart Attacks from occurring. This is what we hope to do. The Society of Cardiovascular Patient Care has formed a Partnership with the Center for Medicare and Medicaid Services and the American Heart Association to support the "Million Hearts Initiative" that aims to reduce the number of Heart Attacks by One Million over the next 5 years by reducing the Risk Factors for Heart Disease using the ABCS Approach. If the 700 Accredited Chest Pain Centers are safely discharging 85% (1500 patients) of patients seen in their Observation Unit each year, doing the math will lead one to conclude that we have the chance to modify the lifestyles of over One Million patients each year. This should be more than enough to get to our Goal Numbers. If so, the Chest Pain Center Movement will be playing a Major Role in the Eradication Heart Attack Deaths in the United States by carrying out these two strategies … and doing it in our Lifetime.

Best of Luck in Saving A Life,
Raymond D.Bahr MD

To participate in the Million Hearts Campaign:

  • Sign the Pledge by visiting the HHS Million Hearts Site
  • In the same line as your organization name, enter "CPC" so HHS knows that you are an accredited facility.
  • Share the link with your contacts so they can register their organization.
  • Notify us via e-mail that you have signed the pledge and your organization will be officialy recognized at the 15th SCPC Congress by Dr. John O'Brien, Senior Advisor, Campaign Leadership & National Field Director at the CMS Innovation Center