Optimal Frequency of Patient Monitoring and Intensity of Oral Anticoagulation Therapy in Valvular Heart Disease

Age-adjusted mortality due to cardiovascular disease (CVD) has declined by more than 50% over the past three decades; however, CVD continues to be the leading cause of death in the United States. In 1994, 1.25 million people experienced an acute myocardial infarction (AMI). Nearly 500,000 Americans died from CVD, and more than half of these deaths occurred suddenly, within 1 hour of symptom onset, outside the hospital setting. The National Heart Attack Alert Program (NHAAP) endorses the view of the American Heart Association that the community should be recognized as the ultimate coronary care unit. Rapid identification and early treatment are supported by research that demonstrates time is a fundamental factor in reducing morbidity and mortality from AMI and cardiac arrest. A dramatic relationship has been shown between the onset of AMI symptoms, reperfusion treatment, and outcome for patients treated within the first hour after the onset of symptoms. The golden hour has become a widely recognized term in the trauma field, and communities and states are encouraged to develop and implement regional and statewide plans to ensure that trauma patients receive appropriate care within 1 hour of injury. The primary premise of this report — that planning by communities for rapid recognition and triage of patients with symptoms and signs of acute coronary syndromes will result in better outcomes for patients with AMI, including sudden cardiac arrest — is largely based on experience with trauma patients, a population that is benefitting from similar community planning efforts. This NHAAP report reviews community planning considerations and the essential components of an effective community plan (i.e., action plans and protocols, equipment and resources, education and training, and continuous quality improvement evaluation and research) and provides recommendations for each component. The report also presents strategies to guide communities in developing community cardiac emergency action plans.