PHA and PhilHealth doctors fr. L: Drs. Philipp Ines, Lowe Chiong, Melanie Santillan (PhilHealth), Jonald Lucero, Danielle Louis Villanueva, Cecileen Anne Tuazon
MANILA — The University of the Philippines–Philippine General Hospital (UP-PGH) is breaking systemic bottlenecks and radically re-engineering its Acute Coronary Syndrome (ACS) protocols, turning a national healthcare sub-allocation into a powerful blueprint for emergency cardiac care.
University of the Philippines-Philippine General Hospital Cardiovascular Medicine Clinical Pathway Coordinator Dr. Cecileen Anne Tuazon, during a session at the Philippine Heart Association (PHA) 56th Annual Convention and Scientific Meeting on May 28, 2026, shared how the implementation of the Philippine Health Insurance Corporation (PhilHealth) Ischemic Heart Disease–Acute Myocardial Infarction (IHD-AMI) package forced the premier state hospital to systematically rewrite its emergency operations.
"So in PGH, the implementation of the package actually resulted in revision of our pathways," she said.
"We already have an existing acute coronary syndrome pathway, which we had to revise several times in order to accommodate po 'yung requirements, for example, the documentary, requirements, and, of course, to improve 'yung patients and document flow inside PGH," she added.
PGH's pathway, currently in 9.4 version, continues to evolve as the administration encounters problems and get feedback from its users as discussed in their regular meetings.
High volume, equitable care
The package's rollout opened with an inferior wall ST-elevation myocardial infarction (STEMI) case in December 2024 through March 2026, having served 848 patients already.
Around 72 percent of all admissions were processed under No Balance Billing (NBB), while the remaining 28 percent were admitted under a co-pay structure.
"This demonstrates that the pathway still primarily serves those who are financially challenged, the vulnerable populations. And so it's very important na sustainable 'yung package-based care," Tuazon said.
Since PGH operates as a specialized Percutaneous Coronary Intervention (PCI)-capable center, patients skip intermediate transfer or pharmacoinvasive protocols.
Instead, the vast majority utilized Package A (the primary revascularization tier) with or without cardiac rehabilitation, while 14 percent availed of Package B+D and 10 percent required Package D alone.
Anatomy of the PGH cardiac patient
Of the 848 acute heart attack patients, about 73 percent of the population are males. They range from 16 years old to 89 years old with a mean age of 57 years old.
Cardiovascular risk factors remain aggressively high. Hypertension topped the list at 69 percent followed closely by a high prevalence of smoking.
Of the total population, about 60 percent of 531 patients suffered a STEMI (a completely blocked coronary artery). Meanwhile, about 37 percent or 317 patients presented with a Non-ST-Elevation Myocardial Infarction (NSTEMI).
For incoming STEMI patients, about 76 percent were classified as Killip Class I, showing preserved hemodynamic stability upon admission.
The remaining caseload fell into Killip Classes II and III, while **9%** presented in severe cardiogenic shock (Killip Class IV).
Striking 100 percent medical compliance
To match Philippine Health Insurance Corporation’s (PhilHealth) stringent quality markers, PGH achieved an uncompromised 100 percent compliance rate in loading the standard acute coronary syndrome medication regimen (Aspirin and dual antiplatelet therapy) among eligible patients, alongside 100 percent compliance for high-intensity statin administration.
The hospital also engineered an innovative bypass for pharmacy supply chain limitations.
Initially, only Clopidogrel was readily available.
PGH upgraded its clinical capabilities through the collection of medication samples from medical representatives and routing them through the institutional pharmacy.
To date, approximately four in every five, or 80 percent of their P2Y12-inhibitor eligible STEMI patients are successfully loaded with the more potent agent, Ticagrelor.
Furthermore, about 77 percent of the total patient population was successfully referred to the cardiac rehabilitation team.
The remaining 23 percent who missed referral were due to strict clinical contraindications, patient/physician choice, or because the patient expired before the 6-day rehab protocol could be completed.
Revascularization breakdowns
For the STEMI group, 89 percent underwent emergency PCI, while 11 percent received a Coronary Angiogram (CA) only.
Among the CA-only cohort, 6 percent presented with non-obstructive coronary disease, while 5 percent revealed complex multi-vessel disease requiring a referral for Coronary Artery Bypass Graft (CABG) surgery.
For the high-risk NSTEMI group—stratified by European Society of Cardiology (ESC) guidelines (as 82 percent high risk and 18 percent very high risk), about 64 percent received a PCI while 36 percent underwent a CA only.
Within this NSTEMI angiogram pool, 25 percent (86 out of 317 patients) showed non-obstructive coronary artery disease, and 11 percent were routed to CABG due to multi-vessel blockages.
The metric that best defines PGH’s clinical re-engineering is time-to-treatment.
Historically, door-to-ECG time hovered at a sluggish 45 minutes. Through iterative pathway revisions, this dropped to a median of 16 minutes at the package’s launch, and has now settled into a tight 6 to 10-minute window.
The massive hurdle, however, remains the door-to-wire crossing time for emergency angioplasties. The figures logged were 274 minutes for pre-IHD-AMI baseline, 185 minutes during the package launch in December 2024, 163 to 164 minutes in early 2025, 150 to 152 minutes post-August 2025 (Hub-and-Spoke).
Recognizing that internal hospital efficiency had plateaued by mid-2025, PGH launched a targeted outreach to external friction points.
In August 2025, the hospital initiated the Heart Saver Project, a hub-and-spokes referral network led by Dr. Eric Sison.
PGH specialists embedded themselves in local, non-PCI capable institutions like the Hospital ng Maynila* and Hospital ng Santa Ana, conducting lectures and solidifying formal transfer workflows.
The strategy yielded an immediate statistical divergence between uncoordinated drop-ins and structured transfers.
Uncoordinated transfers suffered a long 197-minute median door-to-wire time. In stark contrast, coordinated network transfers dropped to a median of 142 minutes, with the fastest record clocking in at a blazing 47 minutes.
"I think it's important po yung sa coordinated transfers kasi lalo at nighttime. Doon naman siya nakakatalo at nighttime because wala yung cath lab team at night," she said.
This structural optimization expanded guideline compliance. The percentage of STEMI patients getting their vessels opened within the gold-standard 120-minute window rose from 11 percent to 28 percent.
For NSTEMI care, the transformation was even more absolute: early invasive coronary angiograms during admission went from a baseline of 12.5 percent in 2019 and 33 percent mid-pathway, to 100 percent compliance post-implementation.
