Myocardial Infarction (MI) is commonly known as Acute Myocardial Infarction (AMI) is a heart attack disease in which blood supply to a part of the heart is interrupted resulting in ultimate irreversible damage and cell death in that part of the heart (Khan, 2010). As one of cardiovascular diseases, myocardial infarction can be regarded as one of the leading causes of death for men and women across the globe. While the condition is attributed to various causes, the major cause of myocardial infarction is partial or complete occlusion of the coronary arteries. The partial or total occlusion of the coronary arteries occurs because of a rupture of an atherosclerotic plaque. This paper provides a detailed analysis of the existing primary health care services used to target myocardial infarction in Australia. The analysis of the current primary health care services and initiatives that exist to target the condition is followed by a proposal to enhance the existing services in Australia that address the condition.
Current Primary Health Care Services and Initiatives toward Myocardial Infarction:
Similar to other cardiovascular diseases, myocardial infarction can be considered as one of the leading causes of deaths in Australia for several decades ("Cardiovascular Disease Mortality," 2010). Cardiovascular diseases account for over 46,000 deaths in Australia every year while an additional 3.7 million people in the population have long-term cardiovascular diseases. Since myocardial infarction is a heart condition with significant impacts, several primary health care services and initiatives have been developed to target the disease. While some of the services and initiatives have helped in treatment of the disease, there is need for improved treatment for myocardial infarction. The new initiatives to lessen delay in response to the symptoms of acute myocardial infarction must consider the emotional and cognitive processes and differences in response to the patients' specific cultures (McKinley, Moser & Dracup, 2000, p.246). However, the main primary health care services and initiatives that exist to target this condition include & #8230;
Cardiac Hospitalization Atherosclerosis Management Program (CHAMP):
Throughout the years, emergency physicians have channeled their efforts towards rapid evaluation and targeted intervention as means for addressing the most severe medical manifestations of myocardial infarction. This is mainly because the condition can be largely identified with an electrocardiogram and the clear understanding of time-dependent benefit of reperfusion therapy. As a result of these initiatives, quality improvement efforts have evolved to focus on care of myocardial infarction patients.
The improvement of clinical outcomes for acute myocardial infarction patients has led to the introduction of the first health care initiative i.e. Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). CHAMP focused on implementing secondary prevention treatments and risk-lessening counseling (Bottorff, Nutescu & Spinler, 2007, p.1145). As part of enhancing the utilization of secondary-prevention drug therapies, the initiative involves the use of focused treatment algorithm, educational lectures, and standardized admission orders.
Get with the Guidelines (GWTG) Program:
The success of CHAMP contributed to the development of another health care initiative to target acute myocardial infarction i.e. The Get with the Guidelines Program, which uses an internet-based data-management system to facilitate analysis of the care of these patients while in hospital. The health care initiative also facilitates the evaluation of hospital performance in relation to adherence to the guidelines. GWTG incorporates prospective collection of data, measuring performance, and reminder screens to give immediate reference to the relevant guidelines and alerts if there is omission of measurements and interventions.
Since its introduction, the initiative has been expanded nationally and proven to be a sustainable and effective continuous quality improvement program that capitalizes on the teachable moment. This concept is related to the introduction of suitable secondary prevention therapy after a percutaneous coronary intervention and linked enhancements in treatment rates and long-term compliance and clinical outcomes of patients.
One of the major primary health care services that exist to target myocardial infarction is thrombolytic therapy. Thrombolytic therapy is a primary health care service that is used for a percentage of patients with acute myocardial infarction who require thrombolysis ("Measure Summary," 2007). Thrombolytic therapy is carried out within 30 minutes of presentation to the emergency department as a primary treatment method within the 6-month time period. The immediate objective of this treatment procedure is to establish reperfusion promptly to secure the myocardium and sustain the left ventricular ejection fraction. This treatment method is based on the fact that segment elevation myocardial infarction takes place secondary to an abrupt interruption of coronary blood supply to a part of the myocardium because of total thrombotic occlusion of an atheromatous coronary artery.
According to the findings of multi-centre studies, the mortality rate of acute myocardial infarction is directly linked to the time delay before the beginning of definitive therapy. While many health care organizations with cardiac cauterization facilities accomplish the restoration of coronary blood flow through emergency angioplasty and stenting of the affected artery, thrombolytic therapy is an effective treatment procedure. When carried out after diagnosis is established and any contraindications like high risk of bleeding are excluded, thrombolytic therapy helps in restoration of coronary blood flow.
Strengths and Limitations of the Services and Initiatives:
The primary health care services and initiatives are associated with various strengths and limitations that determine their effectiveness in targeting myocardial infarction. The strength of Cardiac Hospitalization Atherosclerosis Management Program is that its implementation accomplished a significant increase in the use of life-saving drugs (Bottorff, Nutescu & Spinler, 2007, p.1148). Moreover, the initiative shows a systems approach to quality improvement that increases the use of guideline-recommended therapies and minimizing the risk of recurrent incidents. In contrast, the Get with the Guidelines initiative has been a sustainable and effective ongoing quality improvement program, which is its strength. The strength of thrombolytic therapy is that it lessens mortality and infarction size in acute myocardial infarction patients within the first 90 minutes of symptoms.
Despite the strengths of each of these primary health care and initiatives, they also have certain limitations. Thrombolytic therapy is only effective when it's administered within minutes of identification of symptoms of acute myocardial infarction. This implies that the procedure is not appropriate after the symptoms have lasted for a while. The limitation of the CHAMP initiative is that it focuses on the execution of secondary prevention treatments rather than primary treatment measures. On the contrary, the GWTG initiative is limited on the basis that its data collection procedure is dependent on the willingness of the patient to adhere to the advice of the health care provider.
Primary Health Care Concepts:
In addition to having varying strengths and limitations, the primary health care services and initiatives that target myocardial infarction are based on some primary health care concepts. Cardiac Hospitalization Atherosclerosis Management Program and Get with the Guidelines health care initiatives are based on the concept of secondary treatment and care. This is mainly because the two initiatives are characterized with efforts to enhance the use of secondary-prevention drug therapies. The initiatives are also based on systems approach towards quality improvement and enhancing patient outcomes through secondary prevention and treatment measures. On the contrary, thrombolytic therapy is based on the concept of treatment through hospitalization and/or drug use. The hospitalization and/or treatment are geared towards restoration of coronary blood flow.
Proposals for Improving Services that address the Condition in Australia:
According to the Australian Institute of Health and Welfare, one of the major ways used to address myocardial infarction is hospitalizations with AMI, which accounts for a huge percentage of coronary heart disease hospitalizations ("Cardiovascular Disease," 2011). While these measures has been relatively effective in addressing the disease, the consistency of acute myocardial infarction coding is usually affected by several factors including changes in sensitivity and specification of diagnostic tests. However, there is a huge need to adopt new measures to enhance how myocardial infarction is addressed in Australia. Some of the major ways for improving these services include & #8230;
Chronic Aspirin and Statin Therapy:
Chronic aspirin and statin therapy is a primary health care service that could improve how myocardial infarction is addressed in Australia. This therapy procedure is associated with decreased risk of subsequent myocardial infarction because of the cardio-protective role of aspirin and statins. Based on the findings of an evaluation on a community-based sample of patients with AMI, chronic aspirin and statin therapy is linked to a cardio-protective role that is seen in patients with chronic kidney disease (Scholarly Editions, 2011, p.178).
REACT Theory-based Intervention:
The other important method for enhancing how myocardial infarction is addressed in Australia is through the use of REACT theory-based intervention. The Rapid Early Action for Coronary Treatment (REACT) intervention is a multi-component procedure designed to lessen patient delay for hospital-seeking acute myocardial infarction patients. This intervention is based on the concept that the morbidity and mortality of AMI is usually reduced through reperfusion therapies administered within the first few hours of the onset of symptoms (Raczynski et. al., 1999, p.325). The intervention seeks to provide timely therapeutic care components to AMI…