Irish Heart Attack National Report 2017-2020

The Irish Heart Attack Audit focuses on the care of patients who have suffered a major heart attack in Ireland. This type of heart attack is known as an ST elevation myocardial infarction (STEMI).

This report analysed data on 5,629 patients with a STEMI over a four-year period, 2017-2020. The gold standard treatment for these patients is primary percutaneous coronary intervention (primary PCI). This involves inserting a wire into the blocked artery in order to open it with a balloon and stent and should be performed in a timely fashion, defined internationally as equal to or less than 120 minutes from first medical contact. Since 2012, a standardised national STEMI care pathway has delivered primary PCI at 10 PCI locations in Ireland aiming to improve access to and the timeliness of primary PCI.

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Key Findings

A heart attack is a serious medical emergency. A key message from the report focuses on the importance of calling 999/112 as soon as someone experiences any symptoms of a heart attack. This ensures that they receive a timely pre-hospital ECG diagnosis of STEMI by ambulance personnel and are then directly transferred to an appropriate PCI centre. Only 37% of patients with a STEMI sought medical help within 60 minutes of onset of their symptoms. Sixty-eight percent of patients were admitted to a PCI directly, with 28% still presenting to a non-PCI hospital first. This can lead to delays in reperfusion which directly affects heart attack survival

Current smokers present with heart attack at a much younger age

Whilst high blood pressure and high cholesterol were the most common risk factors for heart attack identified, active smoking remains disproportionately high in people admitted with a STEMI. Thirty-four percent of patients with a STEMI were active smokers at the time of their heart attack. This compares to an average national smoking rate of 17% in the general population. The majority (64%) of heart attacks in younger people aged under 40 years occurred in active smokers. Smoking causes heart attack at a much younger age (median age among males: 56 years for smokers versus 65 years for non-smokers; median age among females: 60 years for smokers versus 76 years for non-smokers).

Key Recommendations

Recommendations For The Irish Heart Attack Audit

RECOMMENDATION 1. Implement a national ST elevation myocardial infarction (STEMI) transfer form for use when transferring patients from a non-percutaneous coronary intervention (PCI) hospital to a PCI centre.
RECOMMENDATION 2. Improve the data quality of the follow-up dataset within the Heartbeat portal.
RECOMMENDATION 3. Develop a process for accessing accurate 30-day mortality rates in patients with a STEMI using the death register in the Central Statistics Office (CSO).

Recommendations For The Health Service Executive

RECOMMENDATION 4. Introduce a key performance indicator that measures the ‘door in door out’ time with the aim of achieving the European Society of Cardiology’s guideline target of 30 minutes or less.
RECOMMENDATION 5. Improve timeliness of reperfusion for patients with a STEMI presenting to non-PCI centres.
RECOMMENDATION 6. Develop a public awareness campaign to encourage people with heart attack symptoms to call 112 or 999 immediately for emergency help in order to facilitate pre-hospital electrocardiogram (ECG) diagnosis of a STEMI.
RECOMMENDATION 7. Improve the identification and control of cardiovascular risks.
RECOMMENDATION 8. Improve public awareness of the adverse impact of smoking on heart attack risk.