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Olean General Hospital

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OGH's Chest Pain Center diagnoses nearly 250 patients in first year

Posted on: 06/14/2010

Chest discomfort may not always be an indication someone is suffering a heart attack but those patients have still been getting prompt diagnosis and treatment at Olean General Hospital’s Chest Pain Center.

More than 90 percent of the nearly 250 patients admitted to the Chest Pain Center were diagnosed, discharged in less than 24 hours with appropriate treatment and instructions without having to undergo needless testing.

A year ago the idea for a Chest Pain Center was introduced by Timothy J. Finan, President and CEO of Olean General Hospital and parent company Upper Allegheny Health System (UAHS), and William Mills, M.D., Senior Vice President of Quality and Professional Affairs at UAHS. They wanted to establish a state-of-the-art service to patients entering the Emergency Department with chest pain.

The Center is for patients whose medical evaluations do not indicate evidence of heart attack, but a large number of them may have chest pain due to other conditions such as girth, chest wall pain, a clot in the lung which is called a pulmonary embolism, gallbladder disease, and many other conditions in which symptoms may include coronary artery disease. A number of patients with chest pain may have had normal electrocardiograms and blood tests.

The purpose of this Chest Pain Center has been to provide a state-of-the-art service and evidence-based care to these patients by qualified cardiologists, and to avoid unnecessary angiograms which are costly, inconvenient, and require transfer to tertiary hospitals in Buffalo or Rochester.

Olean General’s Chest Pain Center is equipped with 2-D echocardiography, 3-D echocardiography, transesophageal echocardiography, various forms of stress tests, 64-slice CT scanner, nuclear medicine, pacemaker implantation, skilled Emergency Department personnel, well-trained technologists and nurses, and board-certified cardiologists.

The Chest Pain Center has shown its value to the community during its first year, said Center Director Ahmad Hilal, M.D. He and Ashok Kothari, M.D., are both board-certified cardiologists who oversee patients’ cases.

“The Chest Pain Center has provided service to nearly 250 patients who were admitted with chest pain and no evidence of heart attack,” said Dr. Hilal.

After appropriate Emergency Department evaluation, followed by observation and consultation with Drs. Hilal or Kothari, patients undergo cardiovascular testing. This can involve stress echocardiograms or nuclear stress tests.

A stress echocardiogram is a painless test using high-frequency sound waves to examine the heart’s anatomy and function. 

A nuclear stress test uses a very small and harmless amount of radioactive tracer substance injected into the patient. A special camera is then used to identify the X-rays emitted from the tracer. This produces clear pictures of the heart tissue and blood flow.

“The Chest Pain Center has performed very well,” said Dr. Kothari. “It’s a tremendous asset to the community and the hospital. We’re able to fast-track these patients with a diagnosis in less than 24 hours.”

Of the nearly 250 patients brought to the Chest Pain Center for evaluation, “Only 10 percent of patients required a coronary angiogram, a procedure using X-ray imaging to see the inside of the heart’s blood vessels. The remaining patients were discharged home in less than 24 hours and provided appropriate instructions,” noted Dr. Hilal.

As an added support, “The Olean community is fortunate to have such dedicated help from area emergency medical services which quickly transport patients to

Olean General’s fully equipped Emergency Department,” Dr. Hilal said.

Also, the Chest Pain Center at Olean General is so important in providing diagnosis and treatment, and limiting healthcare costs, Dr. Hilal added.

“Our facility at Olean General is unique to have this service available. Without this facility, nearly 90 percent of the patients would have undergone a coronary angiogram, which in our evaluation and opinion would have been considered to not be indicated,” Dr. Hilal said.

“The cost of a coronary angiogram is $9,000, including the inconvenience to the patient and the family, and the time taken from their work and normal activities,” Dr. Hilal said.

The cost for treating cardiovascular disease is progressively increasing.

“Therefore, our emphasis is on prevention and to take care of the risk factors of coronary artery disease,” Dr. Hilal explained.

High blood pressure, diabetes, a history of smoking, high cholesterol, overweight, lack of exercise, and family history are all complex risk factors which can be managed with lifestyle modifications and appropriate medical management.

“There is no doubt that a person would be able to avoid the drastic complications of cardiovascular disease.  We have remarkable medical treatment available which can do an excellent job to take care of the risk factors and minimize the impact of the cardiovascular disease process,” Dr. Hilal said.

Heart disease is closely related to stroke, heart failure, cardiovascular disease and disabilities, longer and repeat hospital admissions, and unwanted returns to nursing homes, Dr. Hilal said. 

The essential principles and guidelines of the Chest Pain Center are approved by the American Heart Association and the American College of Cardiology, said Muhammed Javed, M.D., a board-certified nephrologist who’s Chairman of the Department of Medicine at Olean General and Director of the Dialysis Center. “To ensure every patient is evaluated in the same manner and treated on a one-to-one basis, we are very pleased with the progress of the Chest Pain Center. It certainly will act as a model for establishing many other services that require care on a one-to-one basis,” he said.

At the same time, “Effective, state-of-the-art services and medical management requirements are essential to avoid unnecessary delay and anxiety for the patients and their families,” Dr. Javed said.

Dr. Hilal’s emphasis is that any patient with chest discomfort or pressure in the chest, shortness of breath, discomfort radiating to the arm, jaw or back, dizziness or profound weakness are all important signs of an impending heart attack, unless otherwise proven. 

But women can have what are called atypical symptoms. Sometimes they do not experience chest pain that radiates to the jaw, arm or back, said Dr. Hilal. Also, a diabetic patient may have shortness of breath which should not be ignored.  Weakness, fatigue, pressure in the chest and difficulty breathing may all be impending symptoms of a heart attack. 

“Patients should take any of these symptoms very seriously and 911 should be called. Avoiding delays to the emergency room will save the heart. We do not encourage patients to drive themselves or to be driven by family members. It is better to call 911 which is the best and the safest way to reach the emergency department,” Dr. Hilal said.

According to Denise Fish, RN, Director of Critical Care Services at Olean General, “We provide education to these chest-pain patients when they are admitted to ensure they understand the treatment plan and to help eliminate anxiety.”

Following diagnosis and treatment at the Chest Pain Center, “These patients report a very high satisfaction level with the program,” she added.

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