CEEU : Acute Myocardial Infarction :

How the NHS Manages Heart Attacks

April 2006-March 2007

following link is for a pdf download Printable version of full report in PDF format (556k) *

Executive summary

This is the sixth public report from the Myocardial Infarction National Audit Project (MINAP) on the treatment of heart attack patients. It presents data from all hospitals and ambulance services in England and Wales that provided care for patients with suspected heart attack from April 2006 to March 2007 (2006/7) in comparison with data from the previous year (2005/6).

High quality care includes early diagnosis and rapid treatment to re-open the blocked coronary artery responsible for the heart attack. This is usually by treatment with clot dissolving drugs (thrombolytic treatment) and the prescription of drugs that reduce the risk of further heart attack (secondary prevention medication). Although the majority of patients are treated with thrombolytic drugs, an increasing number now receive primary angioplasty instead, and do not appear in the analyses of the intervals from a call for help to treatment with thrombolytic drugs.

The report presents a mixed picture in relation to improvement in the use of thrombolytic drugs. While the overall number of patients having thrombolytic treatment within 60 minutes of a call for help has increased, the number of hospitals achieving this target has fallen. The number of hospitals having less than 20 cases having thrombolytic treatment has also increased by one third. This is a direct effect of the increasing use of primary angioplasty by hospitals. Where thrombolytic treatment continues to be used, greater use of pre-hospital treatment appears to be the best approach to further improvement in delays to treatment.

Patients receive thrombolytic treatment faster

  • There has been further improvement in reducing delays; 64% of patients received thrombolytic treatment within 60 minutes of calling for professional help in England compared with 58% in 2005/6. In Wales the figure was 41%, compared with 30% in 2005/6.
  • In 2006/7, 60% of hospitals, with their associated ambulance services, in England reached or exceeded the national target of 68% for delivering thrombolytic treatment within 60 minutes of patients calling for professional help, compared with 71% in 2005/6.
  • 84% of eligible patients in England received thrombolytic treatment within 30 minutes of arrival at hospital in both 2005/6 and 2006/7. In Wales 70% of eligible patients received thrombolytic treatment within 30 minutes of arrival at hospital compared with 74% in 2005/6.
  • The percentage of hospitals in England providing thrombolytic treatment to 75% of eligible patients within 30 minutes of arrival at hospital is slightly lower: 81% against 88% in the last report in June 2006. In Wales the percentage fell from 47% to 33%. The reasons why performance in Wales lags behind that of England are discussed in the text.

More treatment is being given by paramedics before the patient reaches hospital

The number of ambulance services in England was reduced from 31 to 13 in July 2006. The ambulance service in Wales was unchanged. Twelve out of thirteen ambulance services In England now give thrombolytic treatment to some patients before they reach hospital (pre hospital thrombolytic treatment), while the single ambulance service not using pre-hospital treatment takes all eligible patients to specialist interventional hospitals for consideration of primary angioplasty. Last year 28 of the 31 ambulance services in England and the Welsh ambulance service could give thrombolytic treatment to patients before they reach hospital.

  • In 2006/7, 2,942 patients received pre-hospital thrombolytic treatment compared with  2,231 patients in 2005/6, an increase of 32%.
  • In 2006/7, 91% of patients in England and 90% of patients in Wales who received prehospital thrombolytic treatment received this within 60 minutes of calling for help. There is opportunity for further worthwhile increases in pre-hospital treatment, particularly in rural areas where journey times are long.

More patients are being treated by primary angioplasty

An increasing number of hospitals now provide primary angioplasty as an emergency treatment for heart attack. In England, 35 hospitals have a primary angioplasty service and 21 of these also provide a service for 41 other hospitals. In Wales, 2 hospitals perform primary angioplasty with one other hospital having access to this service. The numbers having primary angioplasty have doubled in the past 12 months.

  • In 2006/7 3,192 patients (3,148 in England and 44 in Wales) were treated with primary angioplasty compared with 1,647 in 2005/6, an increase of 94%.

Prescription of secondary prevention medication continues to exceed national targets

  • The proportion of heart attack patients in England prescribed secondary prevention medication on discharge from hospital continues to exceed the targets, remaining at 97% for aspirin, 91% for beta-blockers and 96% for statins. In Wales there has been a corresponding increase to 99%, 93% and 95%.

Falling mortality for heart attack patients

The percentage of heart attack patients who die within 30 days of admission to hospital has fallen over three years (see Fig. 9 in report).

Improved facilities for patients with acute coronary syndromes since 2000

The following figures are for England only.*

  • There are 69% more cardiologists, 125% more specialty registrars and more specialist cardiac nurses than in 2000.
  • In 57% of hospitals heart attack patients are managed under the care of a cardiologist compared with 25% in 2000, resulting in better outcomes.
  • There has been a 77% increase in the number of hospitals that can provide angiography (the x ray examination off heart arteries) and facilities for angioplasty.
  • There are now 35 hospitals providing a primary angioplasty service, with 21 providing this for other hospitals, compared with 11 in 2000.
  • There has been a 69% increase in the number of cardiac rehabilitation staff since 2000.

* They are based on a survey performed in 2006 and a previous survey – for England only – performed in 2000.

Potential to improve patient care

For the majority of English hospitals, significant reduction in the delay before thrombolytic treatment within hospital is unlikely without compromising safety. There is still room for improvement in Wales. Efforts should be directed to increase the number of patients in England and Wales who receive pre-hospital thrombolytic treatment, particularly where long journeys are involved. A feasibility study on the expansion of primary angioplasty services, the National Infarct Angioplasty Project (NIAP) is due to report in early 2008 and will inform future reperfusion strategy in England. There are also continuing developments in the use of coronary interventions that have the potential to further improve the success rate of thrombolytic treatment.

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This page last updated on July 11, 2007