Life-saving Toronto Heart Attack Collaborative celebrating 5-year anniversary

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Kevin Mundier still remembers the day five years ago when he could have lost his life

In the summer of 2008, at the age of 37, he felt the crippling chest pain of a heart attack – a pain he says was worse than breaking a bone.

Kevin was having a type of heart attack known as a STEMI, or ST Segment Elevation Myocardial Infarction. This severe type of heart attack happens when an artery supplying blood to the heart becomes blocked by a blood clot, and it can potentially lead to death.

But that wasn’t the case for Kevin. He was one of the first people to benefit from the Toronto Heart Attack Collaborative (THAC), an innovative alliance between St.Joseph’s Health Centre and St. Michael’s Hospital in the downtown core.

“I went straight (to St. Michael’s) and they cleared the blockage,” Kevin recalls.

Even though Kevin’s heart attack happened within St. Joe’s catchment area, the joint program – which is a partnership between hospitals in the Toronto Central Local Health Integration Network, Toronto EMS and the Ontario Ministry of Health and Long-Term Care – meant that he was rushed directly to St. Michael’s for their specialized STEMI treatment. It’s a procedure that isn’t offered at St. Joe’s.

“From a patient point of view, they now get the best and most appropriate treatment much more rapidly than they would in the past,” says Sandy Foster, Clinical Care Leader for St. Joe’s Emergency Department.

“Prior to the launch of the THAC program, patients would have to be diagnosed and treated with medications at St. Joe’s, then sent to St. Mike’s for the procedure,” said Erone Newman, director of the Heart and Vascular Program at St. Michael’s. “This wasn’t ideal for STEMI care as it could result in life-threatening delays.”

“(The procedure) has to be done promptly,” adds Julie Ann Ninnis, Patient Care Manager for the Intensive Care Unit and Coronary Care Unit at St. Joe’s. “The slogan that goes with it is ‘time is muscle’ – the heart being a muscle, and the more time that the blood flow to the heart is impaired, the more time for damage.”

There’s a 90-minute window between diagnosis and the procedure where clinicians have the chance to minimize damage, she adds.

To reduce this lag time, the Toronto Heart Attack Collaborative includes training for upper level paramedics in testing for STEMI heart attacks, which means the diagnosis can happen before a patient is taken to a hospital. Foster says it’s a two-pronged approach that includes both paramedics and St. Joe’s Emergency Department staff. Both groups can activate the process to send a patient directly to St. Michael’s for the treatment.

“The paramedics that had dealt with me had just finished their STEMI course,” recalls Kevin. “I had unbelievable luck that day.”

What seemed like luck for Kevin back in 2008 is now routine at St. Joe’s. Ninnis says around 400 patients have benefitted from the program to date, which includes the STEMI procedure at St. Michael’s coupled with follow-up care at the Health Centre’s Coronary Care Unit.

“The collaboration between the two hospitals was the first 24-7 STEMI program in Toronto, and really served as a model for other hospitals across the city,” says Dr. Neil Fam, an interventional cardiologist who leads the project between St. Joseph’s and St. Michael’s. “It’s been a great partnership, and we continue to tweak the system to provide the best care for STEMI patients”.

The struggle now, says Ninnis, is helping patients realize that they might need to make some serious life changes to stay healthy.

“Sometimes (patients) just can’t believe it’s happened,” she explains. “You have a bit of pain, you call an ambulance, and they whisk you over to St. Michael’s.”

The whole experience is over within a few hours, she adds, but that doesn’t mean the heart attack was any less severe.

In Kevin’s case, he took his care team’s advice to heart after his STEMI five years ago – including that of Dalita Ogorkis, a St. Joe’s registered nurse.

“I’m sure I was nagging you about smoking,” Dalita said with a laugh during Kevin’s recent visit to the Health Centre.

Kevin says that since then, he’s quit smoking. “I try to exercise more, and I’ve tried to change my diet,” he adds. The 42-year-old also left his sedentary job as a tow truck driver and now works at a paving company – where he often walks two to five kilometers every day – and decided to learn CPR.

Looking back, Kevin credits the THAC initiative with saving his life.

“I’ve got that program to thank,” he says. “Or I probably wouldn’t be sitting here talking to you today.”