With pulmonary embolisms being one of the leading causes of sudden death, we are faced with a pervasive health crisis that could potentially be averted with stronger treatment regimens and aggressive, consistent standards of care in the U.S. and elsewhere.
At least 600,000 Americans die every year from what was originally believed to be a heart attack when the actual cause was a massive or sub-massive pulmonary embolism (PE) – when part of a blood clot breaks loose and travels through the bloodstream to the lungs, where it can block an artery and cause damage to organs from lack of oxygen. Because symptoms of PE are very similar to that of an acute myocardial infarction, or heart attack, many well-trained hospital-based emergency physicians often misdiagnose the blood clot in the lung that is actually causing the emergency.
Too many high-risk PE patients in the U.S. aren’t getting the most effective and advanced form of guideline-based treatments, and utilization rates of potentially life-saving therapies are low.
The vital role of timely and accurate diagnosis of massive or sub-massive PE can be demonstrated by hospitals and health systems who have reversed high mortality rates associated with the condition. A few examples are: University of Kentucky, Louisville, Massachusetts General Hospital and DMC Heart Hospital. Too few hospitals, however, do not have special guidelines in place, or an inclusive and dedicated team able to quickly respond to complex cases.
Our organization, along with our partners, is trying to bridge the divide between misdiagnoses and saving lives, which would greatly improve our country’s capacity to enhance the way in which PEs are treated. In 2014, our plan to create a Pulmonary Embolism Response Team (PERT) — also called the Clotbusters — was approved for instituting special PE guidelines in DMC Detroit Receiving’s emergency department. With support from Wayne State University medical school and Detroit Medical Center administrators, we coordinated and mapped out a plan for our emergency physicians to use in screening, diagnosing and treating patients.
A few basic practices that hospitals can and should be implementing to stop this silent killer include, for example:
• If a patient presents with chest pains and other heart attack-like symptoms, ER doctors should order an IV, cardiac monitor and EKG, appropriate blood tests, CT angiogram or echocardiogram of the chest and heparin.
• If the CT scan confirms symptoms of PE, a team that can treat PEs should be activated and the patient should be immediately transferred to the catheterization lab for an emergency procedure.
• Once the patient is in a cath lab, the dedicated team trained to treat PEs can begin to do their work and hopefully save a person’s life that might have otherwise been taken due to the very common misdiagnosis of a heart attack.
By the most recent data, we have drastically improved our lifesaving rate to greater than 90 percent over the course of seven years, and have helped other healthcare institutions nationwide who share in our vision to successfully implement similar guidelines in their cardiovascular units. Their participation shows me that more healthcare providers are seeing the close link between high survival rates and PERT teams. A multidisciplinary team made up of interventional cardiologists, fellows, nurses, cardiovascular technologists and radiology therapists able to mobilize twenty-four seven, is just one key to beginning standardized and successful treatment for pulmonary embolisms.
Today, few tertiary and quaternary care providers, including trauma centers, can quickly and effectively respond to easy-to-misdiagnose health emergencies such as a blood clot in the lungs. Our challenge is persuading and educating more hospitals and health systems to invest in the proper techniques and treatment of PE which is needed to prevent unnecessary deaths and costly hospitals stays. If not taken seriously, PE and other misdiagnosed medical emergencies will continue to threaten our ability to manage life-threatening situations within our aging population. Adoption of effective guideline-based standards is crucial to treat the most critically ill and vulnerable among us.
Theodore Schreiber, M.D., is president of the DMC Heart Hospital based in Detroit, Michigan.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.