Irish Heart Attack National Report 2017-2020

Irish Heart Attack National Report 2017-2020 Image

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.

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.