Royal College of Physicians: More than one in five heart attack patients gets primary angioplasty

This year's results from the Myocardial Ischaemia National Audit Project (MINAP) show that more than one in five heart attack patients is receiving primary angioplasty instead of thrombolytic (clot-busting) drugs. Primary angioplasty is a medical procedure to re-open the blocked coronary artery causing the heart attack.

The MINAP project is run by the National Institute for Clinical Outcomes Research at the Heart Hospital, University College London, funded by NQIP, and collects data from all but one eligible hospital in England, all eligible hospitals in Wales and all ambulance services in England and Wales. Results for hospitals, ambulance services and cardiac networks will be available on the Royal College of Physicians website from 10.00 am on Wednesday 25 June.

Since Professor Roger Boyle, National Clinical Director for Heart Disease and Stroke, set out the clinical case for moving to a primary angioplasty service in December 2006 there has been a significant increase in the number of hospitals routinely offering this service.
For example, in London, Birmingham and the Black Country, thrombolytic treatment is now used infrequently due to the rapid increase in provision of primary angioplasty.

This year, in England 54 hospitals have recorded that they have performed primary angioplasty compared with 35 in 2006/7, although 17 of these hospitals performed less than 10 cases. In Wales 2 hospitals perform primary angioplasty.

* In England in 2007/8 4,472 patients were treated with primary angioplasty compared with 3,148 in 2006/7, an increase of 42%.
* In Wales in 2007/8 53 patients were treated with primary angioplasty compared to 44 in 2006/7, an increase of 20%.
* However, 7/30 English cardiac networks have very restricted access to primary angioplasty services (less than 10 cases in 2007/8).
* In England the median door to balloon time (time from arrival in hospital to effective treatment) was 56 minutes and 79% of patients were treated by primary angioplasty within 90 minutes of arrival.
* More than six out of ten patients with heart attack receive one or other form of treatment within three hours of the onset of symptoms.
Primary angioplasty and thrombolysis are most effective within the first 3 hours but the effectiveness of thrombolysis decreases significantly after this time whereas primary angioplasty may still provide some benefit. Those who take longer to be treated are, in the majority, those who take a long time to present to medical attention.

The 2008 report is the seventh report since the project began in 2001, and shows that even more patients than last year are receiving thrombolytic treatment faster:

* 71% of patients received thrombolytic treatment within 60 minutes of calling for professional help in England compared with 64% in 2006/7. In Wales the figure was 49% compared to 42% in 2006/7
* In 2007/8, 66% of English hospitals with their associated ambulance services, reached or exceeded the English national target (68%) for the delivery of thrombolysis within 60 minutes of calling for professional help, compared with 60% in 2006/7
* 85% of eligible patients in England received thrombolytic treatment within 30 minutes of arrival at hospital, compared to 84% in 2006/7. In Wales 68% of eligible patients received thrombolytic treatment within 30 minutes of arrival at hospital compared to 70% in 2006/7.
* 90% of hospitals in England provided thrombolytic treatment to 75% of eligible patients within 30 minutes of arrival at hospital compared to 81% in 2006/7. In Wales 36% of hospitals provided throbolytic treatment to 75% of eligible patients within 30 minutes of arrival at hospital compared to 33% in 2006/7

The prescription of medicines to reduce the risk of another heart attack continue to exceed national targets.

Potential to improve patient care

For the majority of English hospitals significant reduction in the delay before thrombolytic treatment within hospital is unlikely without compromising safety. There is still room for improvement in Wales.
Efforts should be directed to increase the number of patients in England and Wales who receive pre-hospital thrombolytic treatment, particularly where long journeys to hospital are involved.

The increasing use of primary angioplasty will require effective communication between referring hospitals, ambulance services, hospitals where primary angioplasty takes place, and primary care. There have been significant reductions in hospital stay made possible by use of primary angioplasty, with average inpatient stays of less than 4 days compared to 5-6 days with thrombolytic treatment.

Dr John Birkhead, Clinical Director of MINAP, said:
This year has been noteworthy for the increase in numbers of patients receiving pre-hospital treatment (up 8 %) and primary angioplasty (up 42 %).

Professor Roger Boyle, National Director for Heart Disease and Stroke,
said:

"I welcome the publication of the MINAP report, which indicates that NHS patients with heart attack receive a world class standard of care.

"We continue to see improvements in treatment at all levels of the health service, from more pre-hospital treatment given by paramedics, to increased numbers of hospitals able to provide lifesaving primary angioplasty.

"In the light of such good progress, it is immensely rewarding to see the mortality rate for heart attack patients continue to fall.

"We are continuing with our efforts to reduce the number of heart attacks and to save more lives. The proposed vascular checks programme to be rolled out nationally from next year represents a further advance in our national strategy."

Dr Clive Weston, Consultant Cardiologist and Associate Director of MINAP is here in the press office today for interviews and comment. For further information please contact me on the numbers below.


Linda Cuthbertson
PR Manager
Royal College of Physicians
11 St Andrews Place
Regent's Park
London NW1 4LE
Tel: 020 7935 1174 ext.254, 0794 105 7494