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Q&A: How STEMI designation enables Pardee to offer 24-7 cardiac care

From left, Dr. Joseph Moore, Dr. Umberto Fontana and Susan Odom of Pardee accept STEMI letter of designation Mike Barnett and Jimmy Brissie of Henderson County Emergency Services.

By Lightning Reports, Published: February 2, 2021

Joe Moore and his wife were towing a U-Haul trailer over the Blue Ridge mountains last August, helping their newly married son move to Concord outside of Charlotte. Driving 14 hours “gives you a lot to talk about,” he recalled.

A main topic was where the couple might spend the next chapter in their own lives. Their two grown children had moved to the North Carolina and Alabama.

“Where are we going to be close to the kids?” they asked one another. When on a whim he pulled up a job site for doctors, “Pardee Hospital popped up,” Moore said. “Reading what they’re looking for, I told my wife, ‘I can do this. I’ve done that.’”

The job posting sought an interventional cardiologist — exactly what Moore is — and more specifically targeted one with experience running a heart catherization lab that quickly treated heart attack patients.

“It sounded like a great opportunity,” Moore said. “I told the people I interviewed with, ‘You know, I was not looking for a job. But everything I found here was exactly what I wanted to do.’ It became kind of a no-brainer for me.”

The serendipity of the job posting on that summer day led to Moore’s decision to become what he described as “the last piece” in Pardee’s years long effort to step up to the big leagues in emergency cardiac response.

Dr. Joseph Moore leads Pardee's quick response cardiac care team.Last week, the hospital’s Board of Directors received the good news that the North Carolina EMS medical director had designated Pardee UNC Health Care a Percutaneous Coronary Intervention Hospital capable of quality care around the clock for what’s called ST Elevation Myocardial Infarction, or STEMI cases. STEMI is a heart attack caused by clots in one or more of the patient’s coronary arteries. A PCI hospital is equipped with personnel, infrastructure and expertise to diagnose and treat patients who require intensive medical care, specialized tests or interventional therapies.

Pardee had already been operating an interventional cardiac catherization laboratory, with medical and technical staff necessary to perform the full spectrum of life-saving interventional procedures, including minimally invasive PCIs and placement of stents.
The STEMI designation formally recognized the medical team made up of doctors and nurses in the cath lab, the emergency department’s skill in responding to serious heart attacks and the county’s first responder structure, from the 911 center to the paramedics who race to emergency calls.

“Henderson County EMS has worked closely with Pardee on this initiative,” Mike Barnett, Henderson County’s EMS manager, said. “We are excited that Pardee has enhanced their capabilities to provide such a time critical procedure for patients who are experiencing a heart attack.”

After earning his medical degree from the Medical College of Ohio in Toledo, Moore, 60, completed his internship and residency and a fellowship in adult cardiology. He then earned a second fellowship in interventional cardiology at St. Louis University. Here is the Lightning’s Q&A with Dr. Moore on how the county achieved the STEMI designation and how the interventional cardiology procedures save lives and improve medical outcomes.

Why is angioplasty important in saving the victim of a heart attack?

“The most common cause of a heart attack is a layering of cholesterol inside the heart arteries. It ruptures open and a clot forms on it and that clot can block flow down the artery completely and when that happens that causes a heart attack. The basic principal that we operate on is we need to get that artery open as soon as possible. If we can open it within 90 minutes, we know from studies that have been done over the past 50 years that the heart muscle will sustain much less damage, patients will have much less heart failure, where the pump is not working, and much fewer rhythm complications — all the complications you can see with a heart attack. The best way to do that is with a balloon — that’s angioplasty — and 99 times out of a hundred we’ll put a stent in, a metal mesh that goes in on a balloon and goes inside the artery to scaffold the artery open. The idea is to restore that flow again within 90 minutes.”

How does the STEMI designation help?

“There are very few hospitals around the country that have the capability of taking a patient who is suffering a heart attack to a heart catheterization laboratory where we can take actual pictures of the heart arteries and then put a balloon and a stent in to restore the blood flow. The goal for EMS is to try and get patients to the hospital as soon as possible when they find that patient in the field who has a heart attack. Here in Western North Carolina the only hospital that has been doing that (24-7) for the past 40 years is Mission.”

What made the county and Pardee pursue the STEMI designation?

“With the growth that we’ve seen in Henderson County, the Pardee board decided that they wanted to get this STEMI designation for the hospital. The administration has been working long and hard to get all the pieces in place and I’m just kind of the final piece, which I’m very grateful for. That allowed us to say to Henderson County EMS, ‘We’re ready, we can handle this, we have the skill set, we have the equipment that we need, we have the facilities, everything is in place,’ so that Henderson County EMS no longer has to drive past this hospital to go to Mission or any larger hospital.”

Pardee already had the cath lab, right?

“That’s exactly right. The cath lab had been capable of doing angioplasty and stents on all kinds of patients. The issue was they did not have the capability for 24-7 care.” After 6 at night, when the cath lab was closed, the ambulance would “have to drive past” Pardee to Mission. “Those days are gone.” Now the 24-7 cath lab is staffed by Moore and Dr. Umberto Fontana. “We’re recruiting heavily for a third interventional cardiologist so we don’t have to be on call so much.”

How did Pardee and the county emergency services prove that it was qualified for the STEMI designation?

“You have to have the facility, the cath lab and the equipment but more important you have to have the personnel.” Besides interventional cardiologists, the unit needs skilled nurses and technicians with experience treating heart attack patients.

“These patients can many times be the sickest of the sick, and they come in dire straits. You need to have a team that has experience and skills that can take care of those difficult patients. That takes time to assemble that team.” Similarly, the emergency room team has to be trained in cardiac cases and “downstream from the cath lab you have to make sure that the intensive care unit has skilled nurses and the equipment necessary to take care of patients after a heart attack.”

How will this save lives and improve medical outcomes?

“The old adage is time is muscle. Less time (coronary arteries are blocked) the more muscle you save. The sooner you can get to Pardee, the faster we can get the artery open. Our goal, once you hit the door here, we have 90 minutes to get the artery open —that’s the national guideline. We did a heart attack last Thursday” in a patient who had been brought to the hospital by family members. “They activated the cath team so our door-to-balloon time — the first inflation — was 49 minutes.”

The county has invested a lot in recent years to install wireless EKGs in ambulances that communicate instantly with the hospital. How important is the first responder piece of this?

“My impression of these guys and gals (on the county EMS crews) is they’re second to none. They do a great job. When they get there, they’re going to assess the person. The EKG is going to tell them whether there’s a STEMI or not. The idea is to get the patient to our door as soon as possible. Once they’re here, they’re greeted by what seems like chaos but it’s very well-orchestrated chaos.”

What happens when the patient is treated in the cath lab?

“Almost universally, as soon as we open that artery, their chest feels better, their symptoms go immediately away, their color improves, their blood pressure improves. It’s very dramatic sometimes.”

How many heart attack patients can Pardee expect to see now that it has this designation?

“We looked at all those numbers” and calculated that the return on investment was achievable, given 30 to 40 heart attack patients a month. “The number of heart attacks in Henderson County alone exceeds that number” to justify the investment.

What happened to make this possible before you arrived four weeks ago?

“It’s a concerted effort. Certainly, the board and (Pardee CEO) Jay (Kirby) are driving things but they’re responding to the request of the people in the community. My impression is you’ve got a lot of people moving to Henderson County who are coming from all over the country. They want to have the type of services that they had wherever they came from. They don’t want to drive past a perfectly good hospital to go somewhere else to get their heart attack taken care of. The hospital board — kudos to them, they’re responded to that, they’ve been driving that. I feel like everything was put together. I told the board, All I had to do was walk in the door and turn on the lights. This didn’t just happen yesterday. This has been going on for several years now.”

Anything else important about it?

“What we find all the time (in heart attack patients) is they tend to ignore their symptoms. That’s the worst thing that you can do. If a person feels like they’re in trouble, that something’s not right inside, they need to call 911. The guys come out. They’re going to take a look at you. If they think it’s nothing they’re going to tell you that. But if it’s serious, you need to get help right away.” Calling 911 is better than driving to the hospital. “You don’t have a defibrillator in your car.”