The Potential of Community Outreach Programs in Early Heart Attack Care: A German Perspective

Early Heart Attack Care (EHAC) is a community outreach program designed to enhance the quality of prehospital care for individuals experiencing chest pain or other symptoms of acute coronary syndromes (ACS). Since the implementation of the first chest pain centres significantly improved in-hospital care, there is still a pressing need for better education and outreach in the prehospital setting. This need is particularly evident in Germany, where time is muscle and timely reperfusion is crucial in preventing irreversible myocardial damage, disability, or even death.

Background and Importance of Prehospital Care

In the clinical setting, patients with chest pain are treated in specialized Chest Pain Units (CPUs) with defined in-hospital clinical diagnostics, decision-making, and treatment pathways. The German Cardiac Society (GCS) has defined certification criteria that emphasize the paramount importance of reducing prehospital time delays. The concept of "time is muscle" underscores the critical role of timely reperfusion in ensuring the survival of cardiac patients. However, the reasons for prehospital time delays are multifaceted, and a significant factor is that many individuals often misinterpret the symptoms of a heart attack, mistaking them for conditions such as indigestion, muscle pain, or other non-cardiac problems.

Introduction of EHAC

Recognizing the need for better education and outreach in the prehospital setting, the EHAC program was developed in the United States in 2012. This program aims to increase awareness, education, and engagement among patients, their relatives, bystanders, and emergency medical systems (EMSs).

Structure and Components of EHAC

The EHAC program is based on a structured clinical pathway approach, expanding the concept of heart attack care beyond the hospital environment into the community. It involves training bystanders to become active and committed caregivers, beyond traditional medical professionals. The program provides information on the symptoms of a heart attack and encourages individuals to call emergency services as soon as they recognize any symptoms. Additionally, it includes training in basic life support, including cardiopulmonary resuscitation (CPR), to be performed until professional EMSs arrive.

Impact and Success of EHAC

The EHAC program has been successful in the United States, showing significant improvements in the recognition and treatment of heart attacks. The growing interest in bringing the EHAC program to Europe, with Germany as a primary focus, is driven by the recognition of the increasing rates of self-referral of patients and the need for community-based interventions. A working group has recently been established in Germany to develop a tailored program for the German population. This initiative includes an online teaching platform with certification abilities for widespread training of non-professional caregivers, making the program more accessible and effective.

Filling the Gap in Prehospital Care in Germany

Germany has made significant strides in improving in-hospital care for ACS through the certification process defined by the GCS. However, there remains a critical need for better education and outreach in the prehospital setting. The EHAC concept offers a promising solution, aligning with the national goals of improving patient outcomes and reducing morbidity and mortality from heart disease. By enhancing prehospital care, we can ensure that more patients receive timely reperfusion and other lifesaving measures, ultimately contributing to a healthier and more responsive cardiac care system in Germany.

Conclusion

The development of standardized CPUs has significantly improved in-hospital care for patients with ACS, but the prehospital setting remains an area of critical need. The EHAC program, a successful community outreach program in the US, has the potential to fill this gap and improve prehospital care in Germany. Continued investment in this program is essential to reduce prehospital time delays and enhance the overall quality of care for cardiac patients. Implementing the EHAC concept as a baseline element for CPU certification can further enhance the effectiveness of cardiac care in Germany.