Kashmir docs use WhatsApp to treat heart attacks

Srinagar, Sep 28: In 2017, three Kashmir doctors started a unique initiative to handle cardiac emergencies and named it “Save Heart Kashmir” which has so far connected over 1200 doctors virtually, saving hundreds of lives.
The WhatsApp network, which helps to tackle cardiac emergencies, has achieved a milestone and handled over 31,000 life-threatening cardiac emergencies in the past five years.
As per the figures maintained by the group, in the past five years, 1,41,000 EGCs have been analyzed through the initiative while 4,000 thrombolysis procedures were done. Each day, 50-55 ECGs are done through the group while 20-25 cases are handled.
Dr Imran Hafeez, Associate Professor, Department of Cardiology SKIMS Srinagar, who is the founding member of the save heart initiative, said earlier heart attack patients used to reach peripheral hospitals late.
“Our primary aim was to treat cardiac patients in peripheral hospitals within the golden hour. I salute those doctors who take pains and manage patients through WhatsApp. They get expert opinion from doctors who deal with cardiac emergencies day and night,” he said.
Imran said doctors of peripheral hospitals are doing a great job in the initiative. “It is an initiative which isn’t happening in any part of the world. Despite limited health infrastructure, doctors in peripheries are now more confident to treat cardiac emergencies,” he said.
Dr Muzaffar Zargar, Physician Specialist J&K Health Services, said the need of timely management with least delay was felt increasingly and the unique doctor-driven initiative aiming to integrate all levels of health care in Kashmir via medical networking was started.
“It brings emergency cardiac care at the doorsteps so that timely management and expertise is provided to patients across Kashmir without wasting time,” he said.
Since the inception of save heart initiative, local expertise has evolved and most cardiac emergencies are stabilized and managed locally at all district, sub-district hospitals and most of CHCs, PHCs and if needed referred for more advanced cardiac care after stabilization.
Muzaffar, who is one of the founding members of the group, which has covered 130 hospitals across J&K, said ECGs are done, and uploaded within ten minutes of the arrival of patient.
“Response is given by SHK in less than five minutes. Thrombolysis is done in first hour of arrival. In case of referral the next health care delivery is informed while patient is tracked via patient tracking system,” he said.
The initiative made possible expert opinion of cardiologists, and specialists at doorstep to doctors working in remote places for diagnosing, managing cardiac emergencies round the clock.
“Save heart has decreased referral of cardiac patients to tertiary care hospitals and when needed referral after stabilization of cardiac patients,” said Muzaffar.
Save heart initiative has been recognized as a best clinical practice nationally and internationally for managing cardiac emergencies in resource-limited areas by both European and American heart associations.
Dr Nasir Shamas, physician specialist at JLNM Hospital, Rainawari, who is among the founder member of the group said doctors at SDHs contribute 73 percent share in the initiative. Earlier before the initiative, SDHs and PHCs had a minimal role in it.
“SHK aims at providing timely and affordable management in case of acute cardiac events at district and sub-district level hospitals which lacks adequate expertise. It effectively integrates all levels of health care via social networking to diagnose, discuss and thrombolyse the patient in the golden hour at the nearest health facility,” he said.
Nasir said it stresses on use of thrombolysis for treatment in all sub-district and district level health facilities with continuous support of experts through the integrated social network.
“The timely management as first medical contact is the peripheral hospital and receiving thrombolysis at these centres within golden hour is the priority and then patients are subsequently referred for pharma-coinvasive management,” he said.
He said the SHK has contributed to reduced morbidity and mortality in patients suffering from acute cardiac events using social media as a viable tool in cardiac care.
As per Nasir, many health care institutions in India have put forward their interest that they would also replicate the same model as there is zero cost to exchequer.
Quoting a research, he said as Kashmir is prone to cold, studies reveal there are 20-40 percent chances of increase in heart attacks in winters.
As per a research published by Nations within Nations, heart attack is one of the major killers among adults in Jammu and Kashmir.
Kashmir’s two major tertiary care hospitals, SKIMS and SMHS on average receive at least ten heart attack cases in summer and twenty such cases in winter months.
Dr Irfan Bhat, a cardiologist at SMHS Hospital and part of the group said few years back there was a patient from Sopore who had an abnormal connection in the heart which is prone to develop disorder and can cause sudden death.
“The doctor there uploaded the patients ECG report on WhatsApp group. There was no drug available. We advised him to go for DC shock which helped and patient survived,” he said. The patient was then referred to SMHS hospital for catheter ablation.
Earlier, according to health experts, heart attack patients would come to peripheral hospitals and doctors were scared of giving life-saving drugs as they had no expert advice.
“Sometimes an expert doctor is not available so WhatsApp is the option which has helped a lot to save the patients at the peripheral hospitals,” said Irfan.
The network has been extended and is appreciated from many countries across the globe. The group has five WhatsApp groups, where senior physicians and cardiologists of DHSK, SKIMS Srinagar and GMC Srinagar, are in each group and remain active day and night.
“We can’t wait to refer the patients and without wasting time patients are being served via the network. Doctors communicate with each other and it is life-saving initiative,” said a doctor posted in a Pulwama hospital.
The initiative was started in view of the rising death rate among heart attack patients due to the delay in bringing them to the tertiary care hospitals in Srinagar.
Dr Masood Rashid, Anaesthesia Specialist and critical care expert the initiative got huge success just because the directorate of health services Kashmir upgraded emergency rooms (ERs) in peripheral hospitals in far-flung areas.
Masood, who was the team member of ER upgradation committee in 2017, said upgradation was in the form of equipment, machinery, emergency drugs and imparting Advanced Cardiac Life Support (ACLS) trainings to medicos.
“Finally it is a courageous job done by doctors to thrombolyse the myocardial infarction patients in peripheral settings. I hope present DHSK will try to make more advanced medicines like Tenecteplase drug (clot-busting agent) in peripheral hospitals for a better outcome,” he said.