A report just published by the Myocardial Ischaemia National Audit Project (MINAP) shows that the UK treats heart attack patients promptly and effectively. Most patients (8 out of 10) with a heart attack caused by a completely blocked coronary artery are given the gold standard therapy within 150 minutes of calling for help. This success is due to prompt action often by ambulance and paramedic services, who diagnose a heart attack using an ECG at the scene and then transfer the patient to a designated Heart Assessment Centre (HAC) for urgent treatment.
What is the best treatment for heart attack?
A heart attack caused by a completely blocked coronary artery is termed STEMI (ST elevation myocardial infarction)
. This name comes from the shape of the trace seen on an ECG taken shortly after the heart attack. The best treatment involves opening the blocked artery using a small balloon and then putting in place a coronary stent, which scaffolds the artery open. This is known as a primary angioplasty.
Dr Christopher Baker, Consultant Cardiologist at The Physicians’ Clinic says: “Primary angioplasty for heart attack (STEMI) in the UK began in a small number of centres largely in London around 2003. It is a huge credit to the NHS that primary angioplasty is now available country wide and is undertaken in a timely and highly effective manner. This has undoubtedly led to a reduction in deaths and complication rates from heart attacks compared with the older methods of using clot busting drugs.”
What does the report say about treatment for STEMI?
The report reveals that:
- Between April 2012 and March 2013, 77,000 people admitted to hospital with a heart attack were diagnosed with STEMI and required unblocking of a coronary artery.
- Of those 77,000, 95% were given an emergency balloon angioplasty.
- The target of 150 minutes (2.5 hours) from the call for help to the angioplasty was achieved in 82% of cases.
- This target was achieved even though some of the patients were living in remote areas and needed to be transferred large distances to their nearest Heart Attack Centre.
- Delays occurred when patients were first taken to a hospital without a specialist Heart
“ Much of the success of primary angioplasty is due to patients having an ECG done "at the scene" by the ambulance crew and then being transferred not to the local casualty but directly to the catheter laboratory of a primary angioplasty hospital where teams are available at very short notice 24 hours a day,” says Dr Baker.
Heart Assessment Centres also take all patients suffering an out of hospital cardiac arrest. “Many of these are caused by heart disease particularly heart attacks and by other conditions which are best managed in a cardiac unit linked to an Intensive Care Unit,” adds Dr Baker.
What about non-STEMI?
Patients may be taken to A&E, rather than a specialist heart unit but are then referred to an expert team.
- Those patients that are taken to a specialist cardiology team do better.
- 93% are seen by a doctor within the cardiology team within 24 hours of being admitted.
- 47% go to an acute assessment unit with the rest going to a specialist cardiac ward.
Some patients have heart attack symptoms but their ECG trace has important differences in shape. They are classified as non-STEMI
– a slightly less dangerous form of heart attack – and need different early treatment. They need expert monitoring in a cardiac unit so they can have intervention as necessary.
Non-STEMI patients have a partially blocked coronary artery so don’t need a balloon angioplasty as quickly – but it is important that they receive specialist assessment and treatment as their condition can worsen.
“The treatment of patients with acute coronary syndromes (non ST elevation myocardial infarction) which can be viewed as potential heart attacks has also been an area of greatly improved care,” comments Dr Baker.
“As well as taking all STEMI patients, Heart Assessment Centres within hospitals now accept patients with acute heart rhythm changes directly from the ambulance service. They also take any patient with suspected cardiac chest pain due to coronary disease. The aim is to get the patient to a specialist cardiologist as rapidly as possible so that the appropriate treatments can be given to prevent a fatal heart attack.”