Myocardial Ischaemia National Audit Project - University College ...

Patients who received thrombolytic treatmentfor STEMIAs the number of patients having primary PCI has increased,the number having thrombolytic treatment, either before or onarrival at hospital, has fallen.54% of eligible patients received thrombolytic treatmentwithin 60 minutes of calling for professional help inEngland; 48% in Wales. Thrombolytic treatment is not usedin the Belfast hospitals.70% of patients who received thrombolytic treatment orhad no reperfusion treatment had, or were later referredfor, coronary angiography in England; 88% in Wales and74% in Belfast.Thrombolytic treatment given by paramedicsbefore the patient reaches hospitalFor many ambulance services, the focus has shifted fromprovision of early pre-hospital thrombolytic treatment toidentifying those patients with a heart attack who mightbenefit from primary PCI, and transferring these patientsrapidly to a Heart Attack Centre. This means that for manyambulance services the number of patients receiving prehospitalthrombolytic treatment has declined.210 patients received pre-hospital thrombolytic treatmentin England in 2011/12 compared to 824 in 2010/11, adecrease of 75%. In Wales 154 patients received prehospitalthrombolytic treatment compared to 219 in2010/11. Pre-hospital thrombolytic treatment is not usedin Belfast.care units and are not always cared for by cardiologists.However, specialist involvement has been shown to leadto better outcomes. The performance of angiography andcoronary intervention soon, and within the first 2-4 days (seeFigure 17), is an important facet of treatment for the majorityof these patients. Ideally, admission should be to a cardiacfacility where nursing staff have cardiac nursing expertise andthere is easy access to cardiological advice. This year:51% of nSTEMI patients were admitted to a cardiac unit orward in England, 64% in Wales and 87% in Belfast.93% of nSTEMI patients were seen by a cardiologist ormember of their team in England, 81% in Wales and 100%in Belfast. However the Welsh data are incomplete as 3/18hospitals did not enter data on their nSTEMI patients.Prescription of secondary prevention medicationTaking secondary prevention drugs after the acute event(for both STEMI and nSTEMI patients) reduces the risk ofdeath and further heart attack. The proportion of patientsin England, Wales and Belfast who are suitable for suchtreatment and in whom secondary prevention medication isprescribed on discharge from hospital continues at over 95%for each of the five drug classes monitored.Falling mortalityThere has been a year on year fall in the percentage ofpatients with STEMI and nSTEMI who die within 30 days ofadmission to hospital (Figure 19 and 20).Patients that received no reperfusion treatmentSome patients arriving at hospital with evidence of STEMIreceive neither primary PCI nor thrombolytic treatment – noreperfusion therapy is provided – often because they presentto hospital too late to benefit from such treatments, or duringemergency coronary angiography they are found to havecoronary arteries that do not require intervention.In England 30% of patients with STEMI received noreperfusion compared with 31% in 2010/11. In Wales 27% ofpatients with STEMI received no reperfusion compared with31% in 2010/11 and in Belfast 29% of patients with STEMIreceived no reperfusion compared with 30% in 2010/11.Care of patients with nSTEMIPatients with nSTEMI have a lower early risk of deathwithin the first month, but appear to be at similar or evengreater long-term risk than patients with STEMI. Perhapsbecause they do not require very rapid emergency treatment(reperfusion therapy), they are not always admitted to cardiacMINAP Eleventh Public Report 20127