Cardiovascular Medicine in Marin has evolved greatly over the past decade. Long gone are the days when people needed to travel to San Francisco or beyond for advanced, or even basic care for heart attacks, coronary artery disease, heart failure or heart rhythm problems. It is fair to say that all the essential elements of cardiac care are available right here, with demonstrated quality we can be proud of. As I hear radio ads for medical centers in the City, East and South Bay, touting this or that program, it seems to me that we all should be aware of the resources within our own community. A few examples:

• Heart Surgery: Marin General Hospital’s cardiac surgery mortality rate in 2005 was 1.1 percent, compared to a risk adjusted predicted mortality rate of more than 2 percent.



• Myocardial Infarction: For some 10 years, we have treated all acute heart attacks - 24 hours a day, 7 days a week – with immediate coronary angioplasty, because opening the blocked blood vessel as fast as possible is the best way to reduce the risk. The national target for “door to dilation” time (from the emergency department door to an open coronary artery) is 90 minutes; the actual national average time is over 100 minutes. Marin General’s average time in 2005 was 62 minutes. And our heart attack mortality rate was 23 percent better than expected (5.4 percent, compared to a national average of 7 percent). Many of our paramedic rigs now can do electrocardiograms on the scene, allowing earlier diagnosis and faster treatment; we are among the first in the Bay Area with this ability.



• Electrophysiology: Treatment of heart arrhythmias—irregular heartbeats—has advanced remarkably recently and we have been fortunate to be able to open a dedicated facility for these therapies and procedures. We are able to place internal defibrillators and pacemakers, and do even the most complex procedures (including “atrial fibrillation ablation”) with a success rate that would be the envy of any major medical center.

All of this requires a true partnership among our healthcare institutions, our physicians, nurses and other providers, our emergency medical system and our philanthropic community. It would be a shame if we lost that spirit and those results in the storm of politics and rhetoric we hear all too much about.

We have more work to do. Some people in Marin still smoke. Our residents are actually slower, on average, than they should be in calling 911 with chest pain and suspected heart attacks (“it was the chili,” we often hear). There may still be under appreciation of women’s risk and the different ways they manifest heart disease (still the biggest killer for women as well as men). We don’t yet have the ability to do EKG’s on all the paramedic rigs throughout the County.

But we really should stop for a moment and appreciate what we’ve been able to accomplish together for our neighbors, and realize again that Marin is not only a great place to be when you’re healthy, but also an excellent place to stay if your heart ever does become a problem.


Joel Sklar, MD, FACC
Medical Director
Marin Heart Institute
May 2005