Saturday, September 23, 2023

Patients slow to contact emergency services when experiencing symptoms of heart attack – audit

Less than half of patients who experienced a heart attack contacted emergency services within one hour of the onset of symptoms, a clinical audit has found.

The Irish Heart Attack Audit National Report 2021, launched today by the National Office of Clinical Audit, found that just 44 per cent of patients called 999 or 112 within 60 minutes of feeling unwell.

The audit also found:

  • 80 per cent of patients brought directly to the primary percutaneous coronary intervention (PCI) centre by ambulance arrived within the recommended timeframe of 90 minutes.
  • 79 per cent of patients with a STEMI received treatment with primary PCI.
  • Timely primary PCI was higher in patients admitted directly by ambulance to a PCI centre (82 per cent) compared to those transferred to a PCI centre from another hospital (41 per cent).
  • The unadjusted in-hospital mortality rate was 5.6 per cent. Timely treatment was associated with reduced mortality (3.5 per cent vs 5.1 per cent).
  • 39 per cent were smokers at the time of their heart attack, more than double the population rate of smoking (18 per cent). Smokers present with a heart attack nine years earlier than people who have never smoked.
  • 66 per cent of eligible patients were referred to cardiac rehabilitation (target is 90 per cent).

The report was launched by Dr Ronan Margey, clinical lead of the Irish Heart Attack Audit and consultant interventional cardiologist at the Mater private hospital in Cork.

“When patients have symptoms suggestive of a heart attack, we really want to drive a change in public behaviour about accessing care,” he said at the launch.

“It’s very clear from the data that when patients have a pre-hospital diagnosis with an ECG by the ambulance service or an advanced paramedic they have expedited treatment.”

Pauline O’Shea, who suffered a heart attack and is Advocacy Campaign Manager at the Irish Heart Foundation, welcomed the report but raised concerns about its findings.

“Public education regarding (re)acting promptly to possible heart attack symptoms, the importance of ambulance pre-hospital ECG diagnosis of STEMI heart attack, the significance of direct ambulance transfer for Primary PCI and the importance of the timeliness of that treatment, through to outcomes for patients, could literally be costing patients’ lives and affecting survivors’ long-term quality of life,” she said.

“We also need to look at the shortfalls in service delivery this report reveals, as compared with the targets set. Heart attack is a huge issue in Ireland, so we really need to have good public messaging and education married with good service delivery to ensure we deliver best outcomes to patients.”

The audit made four key recommendations:

  • The development of a public awareness campaign to encourage people with heart attack symptoms to call 112 or 999 immediately for emergency help to facilitate pre-hospital electrocardiogram (ECG) diagnosis of a STEMI.
  • There should be a national and regional focus on quality improvement in the STEMI care pathway.
  • Public awareness of the adverse impact of smoking on heart attack risk should be improved.
  • Patients with STEMI should be supported to reduce the risk of further heart attack by increasing the rate of referral to cardiac rehabilitation phase 3.

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