15th April 2016
Up to 30 lives a year will be saved through the introduction of a new standardised treatment for heart attack patients, according to the HSE. Speaking at the launch of a report entitled “Heart Attack Care in Ireland 2014”, HSE Director General Mr Tony O’Brien noted how the report demonstrated that “in 2014, 92% of appropriate patients received angioplasty compared with 55% in 2011. For our patients, this means a better service and more life saving opportunities.”
Congratulating all those involved, Mr O’Brien said “this very significant change is a tribute to the co operation and commitment between dedicated hospital teams and the National Ambulance Service. This modernised approach puts Ireland on a par with our European neighbours.”
The gold standard treatment for a major heart attack (described as a ‘ST Elevation Myocardial Infarction (STEMI) heart attack) is internationally agreed to be Primary Percutaneous Coronary Intervention (also known as angioplasty) as early as possible after the patient first experiences symptoms.
PPCI (angioplasty) is a medical procedure in which a balloon is used to open a blockage in a coronary artery. This procedure usually involves the placement of stents to improve blood flow to the heart.
The HSE, through the Acute Coronary Syndrome (ACS) clinical programme has designated a range of centres across the country to deliver PPCI (angioplasty). According to Prof Kieran Daly, Clinical Lead Programme for ACS: “International evidence has shown that PPCI (angioplasty) intervention is most effective if the dedicated centre can be reached within 90 minutes of diagnosis. The aim of our programme, established over two years ago, was to save lives by standardising the care of these patients across the country. And at 92%, our high level of PPCI (angioplasty) access compares favourably with other countries such as Wales at 72% and England at 97%.”
The establishment of dedicated cardiology teams in the PPCI centres allowing for the maintenance of a 24/7 service with direct access Catheter Laboratories has been an essential development.
Equally important have been developments within the National Ambulance Service. Their vehicles are now equipped with specific ECG machines and paramedics are all trained in their use and interpretation. Paramedics are also trained in STEMI heart attack recognition. Ambulance crews can speak directly with the PPCI centre through a dedicated freephone. A defined protocol has been agreed and implemented which ensures that patients are brought to the most appropriate medical setting.
If a STEMI heart attack patient cannot be transferred to a PPCI centre within 90 minutes, they will be transferred to the nearest Hospital Emergency Department to allow for thrombolysis (clot busting drugs) to be administered. Helicopter transfer for STEMI heart attack patients to the PPCI centre is also an option in certain areas.
According to Prof Daly, once a new cross border service is in place in the coming weeks 90% of the population nationally will have access to a PPCI centre within 90 minutes. “We have been building this service over the last three years and this is a significant development. The small proportion of patients outside this 90 minute transfer time are also dealt with according to national protocols through thrombolysis and then transferred on an urgent basis to a PPCI centre. All international programmes face similar challenges but we feel we are succeeding in reaching a very high percentage of our population at present.”
The designated 24/7 centres are: St James’s Hospital, Dublin; Cork University Hospital; Galway University Hospital; Mater Misericordiae University Hospital Dublin; University Hospital Limerick. University Hospital Waterford operates as a PPCI centre on a nine to five, Monday to Friday basis supplemented by a thrombolysis service out of hours.
A new service in the North West will commence shortly featuring an innovative cross border service that will give Donegal patients suffering from a STEMI heart attack direct access to services in Altnagelvin Hospital, Derry. It is anticipated that up to 60 patients a year will be treated in the Derry hospital.
The report: “Heart Attack Care in Ireland 2014” is available here. Information on the HSE Acute Coronary Syndrome (heart attack) Clinical Programme is available here.
Last updated on: 15 / 04 / 2016