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Heart attack treatment: primary angioplasty overtakes clot-busting drugs

For the first time, heart attack patients in England are more likely to have their damaged artery opened with a balloon catheter (primary angioplasty) than receive clot-busting drugs (thrombolysis).

Figures from the ninth annual MINAP audit released today show that 63% of eligible patients had the balloon catheter procedure, compared to 44% in 2008/9. In Wales the increase was from 11% to 22%.

The MINAP project is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and run by the National Institute for Clinical Outcomes Research, part of the Institute of Cardiovascular Science at University College London. Heart attack is common and remains a major cause of death and ill health. Importantly, prompt and appropriate treatment reduces the likelihood of death and recurrent heart attack. Good treatment coupled with cardiac rehabilitation promotes better recovery.

Preferred treatment

Primary angioplasty for eligible patients is the preferred treatment if it can be provided promptly. Once a patient is recognised as having a heart attack, ambulance staff take the patient directly to the catheter laboratory of the nearest heart attack centre, often bypassing smaller hospitals and the Accident and Emergency (A&E) department. This year's results show that 76% of patients that were treated with primary angioplasty were admitted directly to a heart attack centre in England, and 85% in Wales, meaning that the procedure can be carried out more quickly with better patient outcomes.

As more patients are taken directly to hospital for angioplasty, fewer patients were receiving clot-busting drugs, but of those 69% did receive it quickly, within 60 minutes of calling for professional help. For many ambulance services, the focus has shifted from giving patients the clot-busting drugs in the ambulance before they reach hospital, to making sure patients reach a heart attack centre quickly, so the number of patients receiving treatment in the ambulance has dropped by 36.7%.

These results show a significant sea-change in NHS services, with huge progress towards best practice and better patient outcomes. Also, fewer patients overall are dying following a heart attack, partly because of the need for hospitals to record and publish their results as part of the MINAP audit.

Professor Roger Boyle, National Director for Heart Disease and Stroke, said:

This year we have reached a milestone as more than 60% of heart attack patients receive primary angioplasty. This treatment is a clear example of how the NHS can improve outcomes for patients through more efficient services - it is associated with shorter hospital stays and better patient outcomes.

Clinical audits like this are vital sources of information for patients and clinicians. We want to expand their use in the NHS so that better information leads to better results for patients and health outcomes that are among the best in the world.

Dr Clive Weston, Clinical Director of MINAP, said:

At a time of significant pressures and changes in healthcare, I commend the many clinicians - nurses, doctors, ambulance personnel - who provide care to patients with heart attack and who record data in MINAP. Through their involvement they demonstrate a commitment to the principles of national audit - providing and assuring good quality care, available to people when they need it most.

Iain Thomas, MINAP Patient representative and steering group member, said:

If MINAP were a new drug it would be hailed as a life-saver... helping save the lives of heart patients by encouraging hospitals and ambulance services to improve performance.

David Geldard, MINAP Patient representative and steering group member, said:

It has been wonderful to witness the steady and demonstrable improvement in... services

Professor Peter Weissberg, medical director of the British Heart Foundation, said:

This MINAP report once again demonstrates improvements in treatment of patients with heart attacks and provides confidence that heart patients in England and Wales are receiving a very high quality of care. MINAP is an internationally renowned example of how rigorous audit can drive up clinical standards. Its role will be all the more essential in the coming years to ensure that quality of care is maintained and indeed improved as the NHS funding belt is tightened.