Study points to failures in heart attack care in England and Wales

A BHF-funded team of researchers from UCL and the University of Leeds used data from the UK National Heart Attack Register to analyse the 389,057 cases of non-ST elevation myocardial infarction (NSTEMI), the most common type of heart attack, in 247 hospitals in England and Wales between 1^st Jan 2003 and 30^th Jan 2013.

The researchers looked at 13 treatments that guidelines recommend be considered for patients who have suffered from an NSTEMI, where blood supply to the heart is limited rather than completely cut off. They assessed how often these treatments were given and compared this with whether guidelines at that time suggested that they were appropriate.

Almost 87 per cent of patients did not receive at least one of the interventions that they should have been given. The most frequently missed were dietary advice, advice to help people to stop smoking and the prescription of a type of anticlotting drug known as P2Y12 inhibitors, such as clopidogrel.

The team also looked at the effect that these missed interventions had on the health of the patients within the study. They concluded that some treatments had more impact on patient survival than others. Heart attack patients who should have been given a coronary angiogram, cardiac rehabilitation, advice to help them stop smoking or a prescription for statins but were not, had the highest risk of death.

Someone suffers a heart attack approximately every three minutes in the UK, with nearly 200 people of working age dying every week of a heart attack in the UK.

Dr Chris Gale, Associate Professor of Cardiovascular Health Sciences at the Leeds institute of Cardiovascular and Metabolic Medicine, who led the research, said:

"What we've highlighted here is the unacceptable deficit in the care being given to people after they've had an NSTEMI heart attack. We calculate that roughly one patient per month per hospital in England and Wales is losing their life as a direct consequence of this deficit.

"The good news is that now we've identified the problem, we can certainly fix it. Simple interventions, such as prescribing statins, are being missed and this is resulting in loss of life."

Professor Harry Hemingway (UCL Institute of Health Informatics) and Director of the Farr Institute of Health Informatics Research, said:

"One of the strongest assets of the NHS is the nationwide intelligent information systems which allow us to ask questions about the quality of care and outcomes.   These systems are vital to gauge progress in addressing the (potentially fatal) missed opportunities of care we found." 

Professor Peter Weissberg, Medical Director at the British Heart Foundation, which funded the research, said:

"This study shows that many people in the UK are receiving suboptimal care after a heart attack and that lives are being lost as a consequence.

"Over the years the BHF has invested millions of pounds of donated money on research that demonstrates how best to identify and treat people who have had a heart attack. Hospitals need to apply the lessons learnt from this research and we're committed to working with the NHS to improve patient care.

"Applying clinical guidelines in heart disease costs little and in the long-term saves money and, most importantly, saves lives."

Source: British Heart Foundation 

Links

• Professor Harry Hemingway's academic profile on Iris
• The Farr Institute of Health Informatics

Image

• Ambulance in Motion (Courtesy of Benjamin Ellis)