NICOR: National Institute for Cardiovascular Outcomes Research

 Under this heading please provide a brief and clear description as to what information is being made available on your project’s transparency page.

The datasets contain information on the management of STEMI and nSTEMI in England.

• Primary PCI

• Thrombolytic treatment

• Secondary prevention medication at discharge

• Care of patients with nSTEMI

The analyses contain all records submitted to MINAP within the reporting period. Not all hospitals perform primary Percutaneous Coronary Intervention (PCI), and thus were not included in the call to balloon and door to balloon analyses. 

These data do not include any data about individual patients nor does it contain any patient identifiable data.

The data contained in the CSV files were first published in November 2012 in the MINAP Annual Public Report April 2011-March 2012 – How the NHS cares for patients with Heart Attack.

Data from MINAP requires careful interpretation and the information should not be looked at in isolation when assessing standards of care.

Data are provided by individual hospital that had admitted patients with acute coronary STEMI and nSTEMI.

In practice MINAP records the great majority of patients having STEMI in England and Wales. However it is recognised that a small minority of hospitals do not enter all their nSTEMI patients, mainly due to lack of resources, although in the recent years there has been an improvement in this area. The true number of heart attacks is difficult to establish, as it is not possible to compare MINAP data with Hospital Episode Statistics (HES), the only possible comparator, except in aggregate.

Where a hospital reports less than 20 cases per year, analysis may not be meaningful and the number of cases is shown but not the percentages.

Each year data from MINAP will be made available in CSV file format on the data.gov.uk website. The data can be accessed here:

• MINAP Analyses 2012

The analyses are also available in the MINAP Public Report which also provides commentary on the results. The public reports can be accessed here.

In MINAP, hospitals are measured on their performance against national standards as initially set out in the National Service Framework (2000).

The performance is measured against the following standards of care:

1. Call to balloon within 150 minutes (with all admissions, direct admission only and those involving a transfer from another hospital) - Primary PCI within 150 minutes of calling for help reflects hospital performance and that of the emergency services in identifying STEMI and taking the patient to the Heart Attack Centre (which may not be the closest hospital). Not all patients are taken directly to a Heart Attack Centre, especially where is a diagnostic uncertainty. These figures are based on all eligible records admission diagnosis of STEMI.
2. Door to balloon within 90 minutes - Primary PCI within 90 minutes of arrival reflects the ability of hospital to provide treatment in a timely manner. These figures are based on all eligible records admission diagnosis of STEMI.
3. % of patients with direct admission to the heart attack centre - direct transfer of the patient from ambulance to the catheter lab without involvement of other departments or wards. The denominator is all STEMI patients eligible for primary PCI.
4. Aspirational call to balloon within 120 minutes for all admissions - European guidelines for 2012 propose a CTB within 120 minutes and this is also presented in the table.
5. Call to needle within 60 minutes – This dataset presents results for hospitals that administered thrombolytic treatment to patients with admission diagnosis of STEMI within 60 minutes from of the time of calling for help.
6. Door to needle within 30 minutes - This table presents results for hospitals that administered thrombolytic treatment to patients with admission diagnosis of STEMI within 30 minutes from arrival at the hospital.
7. % of secondary prevention medication at discharge: Aspirin, beta blocker, ACE inhibitor, statins, clopidogrel/thienopyridine inhibitor) - These analyses are based on all patients discharged from hospital with a diagnosis of myocardial infarction. Patients are excluded if they are transferred from the admitting hospital to another hospital for further treatment. Patients are also excluded from analyses if there is a contraindication to a drug, if they refuse treatment, or have severe non cardiac co-morbidity that limits prognosis. ‘n’ represents number of patients that received relevant secondary prevention medication.
8. % of nSTEMI patients seen by cardiologist - It is recognised that not all nSTEMI are entered into MINAP. A number of hospitals report lack of resources to collect data on nSTEMI, and more generally those patients not admitted to cardiac unit are less likely to be entered. Thus the percentages reported below do not take into account ever patient admitted to hospital with nSTEMI but only reflect those entered in the MINAP database. ‘n’ represents number of patients that were seen by cardiologist.
9. % of nSTEMI patients admitted to cardiac unit or ward - It is recognised that not all nSTEMI are entered into MINAP. A number of hospitals report lack of resources to collect data on nSTEMI, and more generally those patients not admitted to cardiac unit are less likely to be entered. Thus the percentages reported below do not take into account ever patient admitted to hospital with nSTEMI but only reflect those entered in the MINAP database. ‘n’ represents number of patients that were admitted to a cardiac ward.
10. % of nSTEMI patients that were referred for or had angiography - It is recognised that not all nSTEMI are entered into MINAP. A number of hospitals report lack of resources to collect data on nSTEMI, and more generally those patients not admitted to cardiac unit are less likely to be entered. Thus the percentages reported below do not take into account ever patient admitted to hospital with nSTEMI but only reflect those entered in the MINAP database. ‘n’ represents number of patients that were referred for or had angiography.

For more information on the above results please refer to the MINAP 2012 Public Report.

All data is reported at the hospital level in England. All but two hospitals (Kingston Hospital and Scarborough General Hospital) that were eligible to take part in MINAP contributed with the data.

The analyses cover the period from 01/04/2011 to 31/03/2012.