Now that Tele-medicine ECG machine is available in Mumbai, at a modest price of Rs.25,000/-, the GPs can take a cardiogram and confirm the diagnosis by the report, sent to them by fax immediately. Then, if an acute myocardial infarction with ST elevation is reported the latest t-PA injection, though very costly (now available in the market), can be given as a single bolus without a drip intravenously by the family doctor at a time, when it will be really useful. Of course the GPs will have to know the contraindications before giving this injection, which can definitely reduce the mortality rate of patients having acute coronary syndrome.
With the increasing traffic in Mumbai, it is more or less impossible to reach any private hospital within one hour. Even if the patient reaches in time and is a good candidate for the t-PA injection, he is asked to pay a deposit of Rs.1-1.5 lakhs immediately! We all know that it is impossible to keep so much cash money in the house, in spite of being fully aware that hospitals do not accept cheques.
STROKE PREVENTION IN ELDERLY PATIENTS WITH ATRIAL FIBRILLATION
Warfarin is highly effective in the prevention of stroke in atrial fibrillation, with a 64% risk reduction compared with 22% for aspirin. Older patients are at the highest risk of stroke.
BAFTA firmly establishes the superior efficacy of warfarin as a stroke-prevention strategy in elderly patients with atrial fibrillation. However, in the future, our greatest challenge will be to identify those patients (elderly or not) who are truly at the highest risk of major bleeding, particularly intracranial haemorrhage. For everyone else, no matter the age group, the benefits of well-managed warfarin substantially outweigh its risks.
David Garcia, Elaine Hylek, The Lancet, 2007; 370 : 460-61.
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.