Calling for help immediately when symptoms of a heart attack begin results in faster treatment and improved outcomes, according to a new report.
Ringing 112 or 999 as soon as anyone experiences the symptoms of a heart attack ensures the ambulance crew can diagnose a serious heart attack and transfer the person to the appropriate specialised treatment centre.
Only 37 per cent of patients suffering a major heart attack – known as an ST elevation myocardial infarction or Stemi – sought medical help within 60 minutes of onset of their symptoms, according to the audit of services by the National Office of Clinical Audit (Noca).
Every year, about 6,000 people are admitted to hospital with a heart attack; one-quarter suffer a Stemi.
The gold standard treatment for these patients is primary percutaneous coronary intervention (primary PCI), which involves inserting a wire into the blocked artery in order to open it with a balloon and stent. This needs to be performed quickly, defined internationally as equal to or less than 120 minutes from first medical contact.
Primary PCI has been performed at 10 locations in Ireland over the past decade.
The report analysed data on 5,629 patients with a Stemi over a four-year period from 2017.
Just 68 per cent of patients were admitted to a PCI centre directly, with 28 per cent still presenting to a non-PCI hospital first. This can lead to delays in restoring the flow of blood (reperfusion), which directly affects heart attack survival. The audit found patients who had a timely primary PCI had a 2.8 per cent in-hospital death rate, compared with 5.2 per cent in patients who are treated beyond the 120-minute window.
Most Stemis (78 per cent) occurred in men. The median age of patients was 63 years (69 years for women and 61 years for men).
The vast majority (84 per cent) of patients brought directly by ambulance to a PCI centre arrived within the 90-minute target time, but only 22 per cent of patients transferred from another hospital to a PCI centre arrived within this time.
Four out of five patients brought to the PCI centre bypassed the emergency department and were taken in directly for treatment.
In patients brought directly to PCI centres by ambulance, the median time between diagnosis of a heart attack and treatment with primary PCI was 84 minutes compared with 155 minutes for patients transferred from another hospital (the target is 120 minutes or under).
Risk factors
High blood pressure and high cholesterol were the most common risk factors for heart attack, but smoking remains disproportionately high in people admitted with a Stemi, according to the report.
Among patients who suffered a major heart attack, 34 per cent were active smokers. This compares with an average national smoking rate of 17 per cent in the general population. Two-thirds of heart attacks in people aged under 40 years occurred in active smokers.
Smoking also leads to heart attack at a much younger age. The median age among males is 56 years for smokers, versus 65 years for non-smokers; for females, it is 60 years for smokers versus 76 years for non-smokers.
Dr Ronan Margey, clinical lead of the Irish Heart Attack Audit, said considerable progress had been made in broadening access to primary PCI at the preferred treatment for major heart attacks. However, challenges remain, with more focus needed on improving symptom recognition, increasing pre-hospital diagnosis of Stemis and then transporting patients directly to PCI centres "so that the right patient receives the right care in the right location at the right time".
