Air ambulance, drugs, can help
Dr. Kevin Coy is backing Heath Minister Anthony Eden’s assessment that it would be unfeasible for the Cayman Islands to set up a cardiac catheterization lab.
He says there isn’t a high enough volume of critical cardiac cases to warrant both a cath-lab, and the team of medical specialists that would be required to man it.
‘The problem is not having a cath-lab; the problem is having a cath-lab that provides quality of care,’ Mr. Coy said.
‘In the Cayman Islands, where you would be doing one case every three or four weeks, it may not be feasible to have a team that is appropriately trained and can provide the quality that would really make a cath-lab feasible.’
A low volume of patients would make it impossible for a cardiologist in the Cayman Islands to maintain his or her skills, Dr. Coy said.
Mr. Coy is an internationally recognised cardiologist and new visiting consultant cardiologist with the Health Services Authority.
‘In the US, the American College of Cardiologists recommends a minimum standard of 75 angioplasty’s per year. In the Cayman Islands, it would be very hard to do that.’
In the Bahamas, where Mr. Coy helped establish a cath-lab, and whose population of over 300,000 dwarfs Cayman’s, only about 40 angioplasty operations are carried out every year, he explained.
A cath-lab is an examination room with special diagnostic equipment used to diagnose, monitor and treat a range of cardiac conditions. One of the most important procedures done in a cath-lab is angioplasty, a procedure in which a tiny balloon in inserted in a blocked artery and inflated, to clear the blockage.
Like Mr. Eden, he believes clot-busting drugs, which can clear blocked arteries without invasive surgery, can play a larger role in emergency cardiac situations.
But, he says they are not being used enough at George Town Hospital because some emergency staff do not have enough training to know when to use them. Mr. Coy will be working with emergency staff in the coming months to fix this problem.
Mr. Coy said clot-busting drugs are particularly important in Cayman because a lack of on-island air-ambulance facilities makes it near impossible to get urgent cardiac patients to Florida before they sustain permanent injury. Cardiologists say patients generally have between 60 and 90 minutes to have a blocked artery cleared before permanent damage is sustained.
In a letter to newspapers in May, former Chrissie Tomlinson Memorial Hospital Consultant Cardiologist Dr. Frank Pillares explained that, in such cases, ‘time is muscle.’
‘The longer it takes to get to a cath-lab from onset of symptoms, the more damage to the heart. A few minutes may mean the difference between death, going back to an active life or not having enough energy to lift your dinner plate from the table,’ Mr. Pillares said.
Mr. Coy believes an on-island air-ambulance, which could slash transfer times, would be a great benefit. But he says it is for others to look at its economic feasibility.
In any event, he said there are many things that could be done to expedite the existing patient transfer process with air-ambulances. He will make recommendations to the HSA and Government in coming months outlining ways he believes this could be achieved.
In a letter to newspapers in May, Mr. Eden said the Cayman Islands lacked the critical volume that would necessitate a cath-lab, given the concomitant expense it would give rise to. But he acknowledged it was a difficult position to take.
‘People’s health and welfare are of paramount importance – but all organisations with finite budgets, including governments, are forced to make these difficult cost-benefit related judgement calls,’ he said.
Mr. Eden said clot-busting drugs are a viable alternative to angioplasty performed in a cath-lab, particularly given that most clot-busting drugs are available in generic form, and angioplasty typically costs $30,000 to $40,000.
He pointed to a recent study in the New England Journal of Medicine that found more than half-a-million people a year were getting unnecessary or premature angioplasty in the US, when clot-busting drugs could be just as effective for clearing blocked arteries.
Mr. Coy took on the position of visiting consultant cardiologist in March, but has many years of experience working in the Cayman Islands and other Caribbean Islands. He helped establish the first cath-lab in the Bahamas and carried out the first cardiac catheterization there. Mr. Coy owns his own practice in Key Biscayne, Florida.
Anyone with cardiac concerns can make an appointment with Mr. Coy by calling the HSA on 949-8600.