Press Release

NHS still world leader in care of heart attack patients

22 June 2006

The fifth public report from MINAP (the Myocardial Infarction National Audit Project), published today, shows that patients with heart attack are being treated at a level of excellence that is unsurpassed anywhere in Europe or beyond. In particular more patients received thrombolytic treatment within 60 minutes of calling for help than last year. This saves lives and contributes to the overall decrease in deaths from heart disease.  This is a remarkable achievement by the NHS.

Most of the work relating to this report was performed at the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit on behalf of a broad multi-professional Steering Group, which includes patient organisations and groups. MINAP has recently relocated to the National Institute for Clinical Outcomes Research at the Heart Hospital, University College London. The project is undertaken in collaboration with the Central Cardiac Audit Database (CCAD) and funded by the Healthcare Commission.*

The fifth MINAP report presents data from all hospitals and, for the first time, ambulance services in England and Wales that provides care for patients with suspected heart attack from April 2005 - March 2006 (2005/6) in comparison with data from the previous year (2004/5). 

High quality care of patients who have had a heart attack includes early diagnosis and rapid treatment to re-open the blocked coronary artery responsible for the heart attack. This is usually by treatment with clot dissolving drugs (thrombolytic treatment) and the prescription of drugs that reduce the risk of further heart attack (secondary prevention therapy).  Although the majority of patients receive a thrombolytic treatment, an increasing number are now receiving primary angioplasty, a medical procedure to re-open the blocked coronary artery responsible for the heart attack, instead of thrombolytic treatment.

For the first time the report shows performance of ambulance services against the call to needle target as the target is shared between hospitals and ambulance services and thrombolytic treatment is increasingly given by paramedics before the patient reaches hospital. More patients are having primary angioplasty -

Main results from the audit:

Patients receive thrombolytic treatment faster

• 83% of eligible patients in England received thrombolytic treatment within 30 minutes of arrival at hospital compared with 44% during early 2001.
• 74% of eligible patients in Wales received thrombolytic treatment within 30 minutes of arrival at hospital, compared to 65% in 2003/4 when the Welsh hospitals were first included in the Public Report.
• 58% of patients received thrombolytic treatment within 60 minutes of calling for professional help in England compared with only 22% in early 2001 (30% in Wales, compared to 22% in 2003/4).

More ambulance personnel can diagnose heart attack and give thrombolytic treatment before the patient arrives at hospital

• 28 of the 31 ambulance services in England and the Welsh ambulance service can now give thrombolytic treatment to patients before they reach hospital (pre-hospital thrombolysis).
• In 2005/6, 2231 patients received pre-hospital thrombolytic treatment compared with 1374 patients in 2004/5.

More patients are being treated by primary angioplasty
More hospitals are now using angioplasty as an emergency treatment for heart attack. This is known as primary angioplasty.

• In 2005/6, 1,647 patients were treated with primary angioplasty in preference to thrombolytic treatment, compared with 1087 in 2004/5.

Prescription of secondary prevention medication continues to increase

• The proportion of heart attack patients prescribed secondary prevention medication  on discharge from hospital continues to exceed the targets remaining at 97% for aspirin, 92% for beta-blockers and 96% for statins in England, with a corresponding increase to 98%, 91% and 94% in Wales.

Dr John Birkhead, MINAP Clinical Director, said

"This large audit confirms the provision of a high standard of care to people suffering heart attack.  It allows those hospitals performing less well to put in place policies to improve performance, and ambulance services to work with hospitals to deliver even more rapid treatments.  As new systems, such as primary angioplasty and pre-hospital thrombolysis are instituted, MINAP will continue assure the quality of care delivered to patients with acute heart attack."

Professor Roger Boyle, National Director for Heart Disease, said

The data summarised in this report shows that patients with heart attack are being treated at a level of excellence that is unsurpassed anywhere in Europe or beyond. The remarkable improvements seen each year since the inception of MINAP are a tribute to the many staff across the country who look after heart attack patients, including the ambulance services, A&E departments, and cardiac care units.

Dr Jonathan Boyce, The Healthcare Commission’s Head of Audit, said

"The fact that levels of pre-hospital thrombolysis have steadily increased is good news.  This reassures patients who have had a heart attack that they will be treated in a timely way that limits the damage to the heart.  It all shows what can be achieved when doctors, nurses and others take it upon themselves to measure how well they are performing and try to improve services."

Dr Clive Weston, a MINAP Associate Director and consultant cardiologist from Swansea NHS Trust, will be in the RCP Press Office during the day and available for interviews and comment.

For further information please contact the RCP Press Office on 020 7935 1174 ext.254 or 468.

* The Healthcare Commission exists to promote improvements in the quality of healthcare and public health in England and Wales. In England, it is responsible for assessing and reporting on the performance of both NHS and independent healthcare organisations, to ensure that they are providing a high standard of care. It also encourages providers to continually improve their services and the way they work.
The Commission is now responsible for directing the clinical audit programme for England and Wales and funds MINAP.  By publicly identifying where improvement is required and sharing good practice within the service, the Healthcare Commission helps the NHS to raise standards of patient care.

Full MINAP report:
http://www.rcplondon.ac.uk/pubs/books/minap06/