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CEEU : Projects : Acute Myocardial Infarction :
How Hospitals Manage Heart Attacks
April 2002-March 2003
Printable version
of full report in PDF format (250k) *
This report covers the performance of hospitals in England caring for people having heart attacks from April 2002-March 2003.
The report contains:
- Introduction
- What happens when you have a heart attack
- Drugs to prevent another heart attack
- National Service Framework standards and targets
- Achievement against targets for heart attack patients by hospitals in England with explanatory notes
- Comment
- Key messages
- Glossary
- Contacts for more information on this report
- Contacts for information on heart conditions
- Acknowledgement
- Hospital location
- 2002 Report
1 Introduction
The National Service Framework (NSF) for coronary heart disease is a 10-year programme published by the Department of Health in March 2000, which set standards of care for patients with coronary heart disease in England (http://www.doh.gov.uk/nsf/coronary.htm). The NSF helps the NHS to plan and deliver the service changes needed to raise standards of care, to improve clinical outcomes and to monitor progress. In addition it promotes equal care for all people with coronary heart disease. In order to make this happen, the NSF has set 12 standards covering areas from prevention to rehabilitation. For more information on what these targets mean for you, see the British Heart Foundation publication: ‘Good Service? The National Service Framework for coronary heart disease. A guide for members of heart support groups, consumer groups and individuals interested in how services for coronary heart disease in England are developed.’
A report on progress towards achievement of the NSF targets, ‘Delivering better heart services’, was published by the Department of Health in March 2003 (http://www.doh.gov.uk/heart/progress2003). A recent report by the Department of Health, ‘Review of Early Thrombolysis’, identifies best practice and makes recommendations for the delivery of faster thrombolysis. (http://www.doh.gov.uk/heart/thrombolysis/review).
The Myocardial Infarction National Audit Project (MINAP) was developed to show how hospitals in England are performing against the NSF targets for patients with heart attacks (myocardial infarction). This report from MINAP concentrates on the time taken to give clot busting drugs (thrombolytic therapy) to suitable patients and the use of drugs to prevent another heart attack (secondary prevention). There is good evidence that both these treatments are highly effective in saving lives.
2 What happens when you have a heart attack
What is a heart attack?
A heart attack occurs when a clot (thrombus) suddenly develops within a heart artery. The heart muscle supplied by the blocked artery suffers permanent damage if the blood supply is not restored quickly.
Thrombolytic treatment
Thrombolytic treatment is the term that describes the use of clot dissolving drugs. Thrombolytic treatment is effective up to about 12 hours after the onset of symptoms but is most effective when given very early after the symptoms. Hospitals and ambulance services are increasingly well organised to recognise heart attacks and provide treatment rapidly.
This report covers patients who were eligible for thrombolytic treatment because they had
- definite signs of a heart attack when they arrived at hospital
- no reason why a thrombolytic drug might be harmful to them and
- no good reason to delay giving the treatment
Thrombolytic drugs are not given until a heart attack is confirmed by an electrocardiogram (ECG). As these drugs are designed to dissolve clots, they may be unsuitable for some patients who are at risk of internal bleeding. Patients at significant risk of bleeding may not be given this treatment where the risk of bleeding is greater than any potential benefit.
3 Drugs to prevent another heart attack
Several drugs are available which have been shown in large clinical trials to reduce the risk of another heart attack. These are called secondary prevention drugs and include
- aspirin, which helps to prevent the blood from clotting
- beta blockers, which slow the heart rate and lower blood pressure
- statins, which reduce cholesterol levels in the blood
Someone who has had a heart attack is normally given these drugs unless they are unable to take them because of side effects.
4 National Service Framework standards and targets
NSF Standard six states that thrombolysis should be given within 60 minutes of calling for professional help (Call to Needle time). In December 2002, 38% of patients achieved this standard and the Department of Health will use this figure as the baseline from which they wish to see a ten percentage point improvement each year.
The NSF target for thrombolysis:
- By April 2002 75% of eligible patients should receive thrombolytic drugs within 30 minutes of arriving at hospital (Door to Needle time). This target was reduced to 20 minutes in April 2003.
The NSF target for secondary prevention:
- By April 2002 80-90% of patients discharged from hospital following a heart attack should be given these drugs.
5 Achievement against targets for heart attack patients by hospitals in England, with explanatory notes
The table in the link below shows how your hospital is performing against the NSF targets. The table has seven columns.
Hospital Hospitals in England that admit patients with heart attacks are listed in alphabetical order. A table in section 12 shows hospital location.
| Door to Needle time (DTN 30) |
This is the time from arrival at hospital when the ambulance stops outside
the hospital (door) to the start of the thrombolytic treatment (needle).
The target time was 30 minutes by April 2002. |
|
| Door to Needle time (DTN 20) |
This is the time from arrival at hospital when the ambulance stops outside
the hospital (door) to the start of the thrombolytic treatment (needle).
The target time was 20 minutes by April 2003. |
|
| Call to Needle time (CTN) |
This is the time from the initial call by the patient or their relative
for professional help to the GP, NHS Direct or the ambulance service (call)
to the start of thrombolytic treatment (needle). This is an NSF standard
and the target time is 60 minutes. |
|
| Aspirin Beta Blocker Statins |
The last three columns show performance against targets for the use of three drugs which reduce the chance of another heart attack. The symbol shown represents achievement against these targets. |
National average
The national average is the overall achievement against the six NSF targets for all hospitals in England that treat heart attack patients.
Achievement against the NSF targets is shown using three symbols:
reached the target
within 25% of the target
more than 25% from the target
Please note that the NSF target for thrombolysis (clot busting drugs) is different
from the target for drugs to prevent another heart attack. The target for Call
to Needle is 38% this year and will increase to 48% in 2004. Hospitals achieving
this are shown by a and those not
achieving it are shown by a .
Hospitals with ‘No Data’
If hospitals have not
returned any data, then ‘No Data’ will appear
in the table. Where analyses are absent enquiries should be made locally to
confirm individual hospital status.
Hospitals with fewer than 20 cases (!)
If a hospital has fewer than 20 cases that meet the analysis criteria, then
! will appear in the table. This may because the hospital is small with
few patients admitted with heart attack and the analysis may not be representative.
In the case of larger hospitals this may be because primary angioplasty
is
being used extensively for the treatment of heart attack. In others failure
to report performance may be the cause.
Hospitals with incomplete data
If a hospital has returned data for less than four quarters of the year,
then an * will appear in the table and the analysis is performed on
incomplete data.
Coverage
This report is based on data from the 12 months from 1 April 2002 -
31 March 2003. This report will be updated in April 2004 for the
period April 2003
- March 2004 and will subsequently be released annually.
PDF
table of hospitals' achievement against NSF targets (175k) nb
this version
is not printable
6 Comment
- This report is based on the average performance of hospitals over 12 months. The number of hospitals achieving the DTN30 target has increased from 52 to 95 since the last report in November 2002. Achievement against this target has increased steadily throughout 2003 and therefore performance for the year from April 2002 – March 2003 will underestimate performance over the last two quarters. In the first three months of this year this target was achieved in 76% of patients.
- The Call to Needle time measures the time taken from the call for professional help until treatment and reflects the performance of the whole service. This is the most relevant indicator of patient care. It will become increasingly important for NHS monitoring purposes.
- While we report here on the achievement of the 60 minute Call to Needle time standard by acute hospitals, we recognise that delivery of heart attack care within this timeframe is a responsibility that hospitals share with NHS ambulance services. Ambulance response times and Call to Door times will therefore be critical in improving overall NHS performance against the 60 minute thrombolysis standard, thus providing more effective patient care and better clinical outcomes.
- The use of medication to reduce the risk of further heart attack has continued to increase. The number of hospitals achieving the NSF target for aspirin has increased from 193 - 202, for beta blockers from 152 - 174 and for statins from 151- 175.
7 Key messages
- The NSF was published in 2000 in order to improve the care of patients with heart attack and to reduce the number of deaths from heart attack.
- The NSF is a ten year programme. This is the second report to be published on the treatment of heart attack.
- Hospital treatment of patients with acute heart attacks are now compared nationally using the same definitions. It enables hospitals to compare themselves against all other hospitals, to establish a baseline for future progress, and monitor improvement in care for people who have suffered a heart attack.
- Measuring performance against these targets can help hospitals identify areas where care for people with heart attacks can be improved.
- Everyone should familiarise themselves with symptoms of a heart attack (for a description of symptoms see page 9 of the British Heart Foundation publication: “'Good Service?' The National Service Framework for coronary heart disease. A guide for members of heart support groups, consumer groups and individuals interested in how services for coronary heart disease in England are developed”).
- Patients should ring 999 for help immediately if the symptoms of a heart attack last more than 15 minutes and are not relieved by resting or using nitrate tablets or spray, if prescribed.
- The largest delay is not usually the arrival of the ambulance or giving thrombolysis, but the delay in calling for professional help.
- Most hospitals will have a Patient Advice and Liaison Service (PALS) which should be able to give advice on your hospital’s performance.
8 Glossary
| Anti-platelet drugs – Drugs including aspirin that prevent the clotting of blood. Anti-platelet drugs act by reducing the ‘stickiness’ of platelets - the small blood cells that can clump together to form a clot. |
| Aspirin – An anti–platelet drug used to help prevent blood clots forming. |
| Beta Blockers – Beta-blockers are drugs that block the actions of the hormone adrenaline that makes the heart beat faster and more vigorously. They are used to help prevent attacks of angina, to lower blood pressure, to help control abnormal heart rhythms and to reduce the risk of further heart attack in people who have already had one. They may also be used in small doses in heart failure. |
| Cholesterol – A fatty substance mainly made by the liver. It plays a vital role in the functioning of every cell wall throughout the body. The body also uses cholesterol to make other vital chemicals. However, too much cholesterol in the blood increases the risk of coronary heart disease and heart attacks. |
| Clot-busters – Drugs used to dissolve blood clots after a heart attack. |
| Electrocardiogram – Also known as ‘ECG’. A test to record the rhythm and electrical activity of the heart. The ECG will show if a person has had a heart attack, either recently or some time ago. |
| Heart Attack – A heart attack occurs when a clot (thrombus) suddenly develops within a heart artery. The heart muscle supplied by the blocked artery suffers permanent damage if the blood supply is not restored quickly. The damage to heart muscle carries a risk of sudden death, and heart failure in people who survive. |
| Heart failure – Heart failure occurs when a damaged heart becomes less efficient at pumping blood round the body. This may result from damage to the heart muscle caused by a heart attack. |
| Myocardial Infarction – A heart attack. |
| Primary angioplasty - An emergency treatment to reopen a blocked artery using a fine catheter with a small inflatable balloon at its tip. This is a relatively new treatment for heart attack which is not yet widely available. |
| Secondary Prevention – Drugs that prevent another heart attack. |
| Statins – Drugs used to reduce cholesterol levels in the blood. |
| Thrombolytic Treatment / Thrombolysis – Treatment which dissolves a clot blocking an artery and restore blood flow to the heart muscle. |
| Thrombus – A blood clot. |
9 Contacts for more information on this report
Myocardial Infarction National Audit Project
Clinical Effectiveness and Evaluation Unit
Royal College of Physicians
London NW1 4LE
Tel: 020 7935 1174 ext.334
Email: minap@rcplondon.ac.uk
http://www.rcplondon.ac.uk/college/ceeu/ceeu_ami_home.htm
Royal College of Physicians
PR Manager Linda Cuthbertson on 020 7935 1174 ext.254
Email: Linda.Cuthbertson@rcplondon.ac.uk
Department of Health
Enquiries to the Department should be directed to the Public Enquiry Office
Tel: 020 7210 4850 (line open from 9.00am to 5.00pm Monday to Friday).
Minicom: 020 7210 5025.
Email at dhmail@doh.gsi.gov.uk
In writing to the Minister for Public Health at
The Department of Health
Richmond House
79 Whitehall
London SW1A 2NS
If you require further information on your local hospital’s performance
please contact the hospital’s Patient Advice and Liaison Service.
10 Contacts for information on heart conditions
British Heart Foundation
http://www.bhf.org.uk/
NB: The British Heart Foundation runs a medical information line that provides
information about heart conditions and their management. It cannot respond
to questions about service provision in individual hospitals. Tel: 08450
70 80 70
The document ‘Good Service’ can be obtained by telephoning 01604
640016 and asking for leaflet code M69.
British Cardiac Patients Association
http://www.bcpa.co.uk/
HEART UK
http://www.familyheart.org/
American Heart Association
http://www.americanheart.org/
NHS Direct
http://www.nhsdirect.nhs.uk/
Tel: 0845 4647
Blood Pressure Association
http://www.bpassoc.org.uk/
DOH website and NSF link
http://www.doh.gov.uk/nsf/coronary.htm
Diabetes UK
http://www.diabetes.org.uk/
British Cardiac Society
http://www.bcs.com/
11 Acknowledgement
This report was completed in close collaboration with the Central Cardiac Audit Database (CCAD) http://www.ccad.org.uk/ who performed data management and analysis.
The Myocardial Infarction National Audit Project acknowledges the contribution of its Patient/Carer Group and British Heart Foundation Patient Focus Groups in the development of this report.
The Commission for Health Improvement (CHI) is the independent inspection body for the NHS. CHI publishes reports on NHS organisations in England and Wales and highlights where the NHS is working well and the areas that need improvement. CHI is now also responsible for directing the clinical audit programme for England and Wales and funds MINAP. By publicly identifying where improvement is required and sharing good practice within the service, CHI helps the NHS to raise standards of patient care.
12 Hospital location
| Hospital | Town |
| Addenbrooke's Hospital | Cambridge |
| Airedale General Hospital | Keighley |
| Arrowe Park Hospital | Wirral |
| Ashford Hospital | Ashford |
| Barnet General Hospital | Barnet |
| Barnsley District Hospital | Barnsley |
| Basildon Hospital | Basildon |
| Bassetlaw District General Hospital | Nottingham |
| Battle Hospital | Reading |
| Bedford Hospital | Bedford |
| Birmingham Heartlands Hospital | Birmingham |
| Bishop Auckland General Hospital | Bishop Auckland |
| Blackburn Royal Infirmary | Blackburn |
| Bradford Royal Infirmary | Bradford |
| Bridlington and District Hospital | Bridlington |
| Bristol Royal Infirmary | Bristol |
| Broomfield Hospital | Chelmsford |
| Burnley General Hospital | Burnley |
| Bury General Hospital | Bury |
| Calderdale Royal Hospital | Halifax |
| Central Middlesex Hospital | London |
| Charing Cross Hospital | London |
| Chase Farm Hospital | Enfield |
| Chelsea and Westminster Hospital | London |
| Cheltenham General Hospital | Cheltenham |
| Chesterfield Royal | Chesterfield |
| Chorley Hospital | Chorley |
| City Hospital | Birmingham |
| Colchester General Hospital | Colchester |
| Conquest Hospital | St Leonards on Sea |
| Countess of Chester Hospital | Chester |
| County Hospital Hereford | Hereford |
| County Hospital Louth | Louth |
| Crawley Hospital | Crawley |
| Cumberland Infirmary | Carlisle |
| Darent Valley Hospital | Dartford |
| Darlington Memorial Hospital | Darlington |
| Derby Royal Infirmary | Derby |
| Derriford Hospital | Plymouth |
| Dewsbury District Hospital | Dewsbury |
| Diana, Princess of Wales Hospital | Grimsby |
| Doncaster Royal Infirmary | Doncaster |
| Dorset County Hospital | Dorchester |
| Ealing Hospital | Southall |
| East Surrey Hospital | Redhill |
| Eastbourne District General Hospital | Eastbourne |
| Epsom Hospital | Epsom |
| Frenchay Hospital | Bristol |
| Friarage Hospital | Northallerton |
| Frimley Park Hospital | Frimley |
| Furness General | Barrow in Furness |
| George Eliot | Nuneaton |
| Glenfield Hospital | Leicester |
| Gloucestershire Royal Hospital | Gloucester |
| Good Hope General Hospital | Sutton Coldfield |
| Grantham and District | Grantham |
| Halton General Hospital | Runcorn |
| Hammersmith Hospital | London |
| Harrogate District Hospital | Harrogate |
| Hartlepool General | Hartlepool |
| Hemel Hempstead General | Hemel Hempstead |
| Hexham General Hospital | Hexham |
| Hillingdon Hospital | Uxbridge |
| Hinchingbrooke Hospital | Huntingdon |
| Homerton Hospital | London |
| Hope Hospital | Manchester |
| Horton General Hospital | Banbury |
| Hospital of St Cross | Rugby |
| Huddersfield Royal Infirmary | Hudderfield |
| Hull Royal Infirmary | Hull |
| James Cook University Hospital | Middlesborough |
| James Paget Hospital | Great Yarmouth |
| John Radcliffe Hospital | Oxford |
| Kent and Canterbury Hospital | Canterbury |
| Kent and Sussex Hospital | Tunbridge Wells |
| Kettering General Hospital | Kettering |
| King's College Hospital | London |
| King George Hospital | Goodmayes |
| Kings Mill Hospital | Sutton in Ashfield |
| Kingston Hospital | Kingston Upon Thames |
| Leeds General Infirmary | Leeds |
| Leicester General Hospital | Leicester |
| Leicester Royal Infirmary | Leicester |
| Leighton Hospital | Crewe |
| Lincoln County Hospital | Lincoln |
| Lister Hospital | Stevenage |
| Luton and Dunstable Hospital | Luton |
| Macclesfield District General | Macclesfield |
| Maidstone General Hospital | Maidstone |
| Manchester Royal Infirmary | Manchester |
| Manor Hospital | Walsall |
| Mayday University Hospital | Croydon |
| Medway Maritime Hospital | Gillingham |
| Milton Keynes General Hospital | Milton Keynes |
| Montagu Hospital | Mexborough |
| New Cross Hospital | Wolverhampton |
| Newark Hospital | Nottingham |
| Newham General Hospital | London |
| Norfolk and Norwich Hospital | Norwich |
| North Devon District Hospital | Barnstable |
| North Hampshire Hospital | Basingstoke |
| North Manchester General Hospital | Manchester |
| North Middlesex Hospital | London |
| North Staffordshire Hospital | Stoke on Trent |
| North Tees General | Cleveland |
| North Tyneside General Hospital | North Shields |
| Northampton General Hospital | Northampton |
| Northern General Hospital | Sheffield |
| Northwick Park Hospital | Harrow |
| Nottingham City Hospital | Nottingham |
| Oldchurch Hospital | Romford |
| Ormskirk and District General | Ormskirk |
| Peterborough District Hospital | Peterborough |
| Pilgrim Hospital | Boston |
| Pinderfields General Hospital | Wakefield |
| Pontefract General Hospital | Pontefract |
| Poole Hospital | Poole |
| Princess Alexandra Hospital | Harlow |
| Princess Royal Hospital | Haywards Heath |
| Princess Royal Hospital | Telford |
| Princess Royal University Hospital | Bromley |
| Queen's Hospital | Burton upon Trent |
| Queen Alexandra Hospital | Portsmouth |
| Queen Elizabeth Hospital | Kings Lynn |
| Queen Elizabeth Hospital | Gateshead |
| Queen Elizabeth Hospital | Greenwich |
| Queen Elizabeth II Hospital | Welwyn Garden City |
| Queen Elizabeth the Queen Mother | Margate |
| Queen Mary's Hospital | Sidcup |
| Rochdale Infirmary | Rochdale |
| Rotherham General Hospital | Rotherham |
| Royal Albert Edward Infirmary | Wigan |
| Royal Bolton Hospital | Bolton |
| Royal Bournemouth General | Bournemouth |
| Royal Cornwall Hospital | Truro |
| Royal Devon and Exeter | Exeter |
| Royal Free Hospital | London |
| Royal Hallamshire Hospital | Sheffield |
| Royal Hampshire County Hospital | Winchester |
| Royal Lancaster Infirmary | Lancaster |
| Royal Liverpool University Hospital | Liverpool |
| Royal London Hospital | London |
| Royal Oldham Hospital | Oldham |
| Royal Preston Hospital | Preston |
| Royal Shrewsbury Hospital | Shrewsbury |
| Royal Surrey County Hospital | Guildford |
| Royal Sussex County Hospital | Brighton |
| Royal United Hospital Bath | Bath |
| Royal Victoria Infirmary | Newcastle |
| Russells Hall Hospital | Dudley |
| Salisbury District Hospital | Salisbury |
| Sandwell Distict Hospital | West Bromwich |
| Scarborough General Hospital | Scarborough |
| Scunthorpe General Hospital | Scunthorpe |
| Selly Oak Hospital | Birmingham |
| Skegness District Hospital | Skegness |
| Solihull General Hospital | Birmingham |
| South Tyneside District Hospital | South Shields |
| Southampton General Hospital | Southampton |
| Southend Hospital | Westcliff on Sea |
| Southmead Hospital | Bristol |
| Southport and Formby District Hospital | Southport |
| St George's Hospital | London |
| St Helier Hospital | Carshalton |
| St James' University Hospital | Leeds |
| St Mary's Hospital | Newport, IoW |
| St Mary's Hospital | Paddington |
| St Peter's Hospital | Chertsey |
| St Richard's Hospital | Chichester |
| St Thomas Hospital | London |
| Staffordshire General Hospital | Stafford |
| Stepping Hill Hospital | Stockport |
| Stoke Mandeville Hospital | Aylesbury |
| Sunderland Royal Hospital | Sunderland |
| Tameside General Hospital | Ashton under Lyme |
| Taunton and Somerset Hospital | Taunton |
| The Alexandra Hospital | Redditch |
| The Great Western Hospital | Swindon |
| The Ipswich Hospital | Ipswich |
| Torbay Hospital | Torquay |
| Trafford General Hospital | Manchester |
| University College Hospital | London |
| University Hospital Aintree | Liverpool |
| University Hospital Lewisham | London |
| University Hospital of North Durham | Durham |
| University Hospital Queens Medical Centre | Nottingham |
| Victoria Hospital | Blackpool |
| Walsgrave Hospital | Coventry |
| Wansbeck General Hospital | Ashington |
| Warrington District General Hospital | Warrington |
| Warwick Hospital | Warwick |
| Watford General Hospital | Watford |
| West Cornwall Hospital | Penzance |
| West Cumberland Hospital | Whitehaven |
| West Middlesex University Hospital | Isleworth |
| West Suffolk Hospital | Bury St Edmonds |
| Westmoreland General Hospital | Kendall |
| Weston General Hospital | Weston Super Mare |
| Wexham Park Hospital | Slough |
| Whipps Cross Hospital | London |
| Whiston Hospital | Prescott |
| Whitby Hospital | Whitby |
| Whittington Hospital | London |
| William Harvey Hospital | Ashford |
| Worcester Royal Infirmary | Worcester |
| Wordsley Hospital | Stourbridge |
| Worthing Hospital | Worthing |
| Wycombe General Hospital | High Wycombe |
| Wythenshawe Hospital | Manchester |
| Yeovil District Hospital | Yeovil |
| York District Hospital | York |
13 2002 Report
The "How Hospitals Manage Heart Attacks" report for 2002 is available in PDF only:
Printable
version of full report in PDF format (320k) *
* PDF files require the free Adobe Acrobat reader.
This page last updated on
August 1, 2007