In-hospital death risk from heart attack, stroke, pneumonia falls

The risk of a patient dying in hospital from heart attack, stroke or pneumonia has fallen dramatically over the past decade, a new report shows.

In contrast, the death rate for one of the most common diseases responsible for hospital admissions, chronic obstructive pulmonary disease (COPD), has remained unchanged, while the rate for heart failure fell only 6 per cent over the past 10 years.

The in-hospital mortality rate for ischaemic stroke (clots in the brain) has fallen 38 per cent over the past 10 years, from 123 deaths to 76 per 1,000 admissions, according to the report from the National Office of Clinical Audit (Noca). The mortality rate for haemorrhagic stroke showed a reduction of 17 per cent, from 302 to 252 deaths per 1,000 admissions.

There was a significant reduction of 35 per cent in the mortality rate for acute myocardial infarction (heart attack) since 2009, from 74 to 48 deaths per 1,000 admissions.

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"The background to these improvements for heart attack and stroke is the increased availability of new drugs such as clot-busting treatments, as well as a move to providing more care in specialised centres," said Dr Jennifer Martin of the HSE's quality improvement division.

‘Statistical outlier’

Pneumonia deaths fell 28 per cent, from 145 to 104 deaths per 1,000 admissions, according to the report. One hospital, Cork University Hospital, is identified in the report as a “statistical outlier” for pneumonia deaths after it breached targets for two consecutive quarters.

Noca says it has engaged with the hospital and a review has been carried out on a random sample of pneumonia cases. This work is ongoing and the result of the review will be carried in next year’s mortality report.

The audit uses data on patient deaths in 44 public hospitals but Noca says it cannot be used to compare hospitals as they each have different patient profiles.

“Some hospitals will have greater numbers of patients with severe conditions; for example, hospitals such as specialist referral centres may only admit patients with more complicated conditions. . . This report cannot and should not be used to produce league tables or to compare hospitals.”

Above average

However, it says hospitals can view their own data in relation to a national average. With heart attack, for example, 12 hospitals had an above average standardised mortality rate – Mullingar, Clonmel, Naas, Waterford, Kilkenny, Tallaght, Mayo (highest), St Vincent’s, the Mater and Galway.

"The results demonstrate the improvements in outcomes for some of the most significant illnesses in our hospitals," said HSE chief clinical officer Dr Colm Henry, who added that the results were being used by hospitals to support improvements.