Why the ACS Programme is doing this?
Primary PCI and angiography
STEMI patients will currently get either a clot busting drug (thrombolysis) or primary PCI depending on what hospital they arrive at. Recent international evidence has shown that primary PCI primary is the most effective treatment of STEMI (major heart attack) and most countries in the developed world have implemented Primary PCI programmes. In most cases these programmes include the use of clot busting drugs (thrombolysis) in areas where the distance/time to a primary PCI centre is too great.
As well as immediate transport of STEMI patients to a primary PCI centre for a primary PCI, the ACS programme is also recommending the transfer of thrombolysed STEMI patients as soon as possible to a primary PCI centre to ensure that angiography can be performed in a timely manner. In some cases a rescue angioplasty (PCI) is required in a PPCI centre when the thrombolysis has failed.
The ACS programme aims to increase (30% to 80%) the percentage of STEMI patients in Ireland getting PPCI by ensuring patients are being taken to the right place, standardising treatment and putting in place processes to ensure prompt investigation of all ACS patients..
Cardiac Rehabilitation and prevention
There is clear evidence that good cardiac rehabilitation programmes that involve exercise programmes and lifestyle changes reduce the number of re-current heart attacks and other ACS events. Established and resourced cardiac rehabilitation programmes are an important part of the ACS programme - this includes programmes to assist smokers to stop smoking.
Response to a heart attack or collapse
The ability to recognise a heart attack or collapse and the importance of contacting the emergency services (ph 999 or 112) early is an important factor in saving lives. For this reason the ACS programme will promote public awareness and support initiatives that improve first response to a collapse.
Where the ACS Programme is being implemented
The programme is being implemented throughout Ireland and involves over 30 hospitals that deal with ACS patients. The designated primary PCI centre hospitals are:
St James's Hospital (24/7)
Mater Misericordiae University Hospital (24/7)
Cork University Hospital (24/7),
Waterford Regional Hospital (9-5, Mon-Fri centre)
University Hospital Galway (24/7)
Mid Western Regional Hospital, Limerick (24/7)
Since January 2013 the ambulance service has used the ACS optimal reperfusion service (ORS) protocol in transporting STEMI patients to designated PPCI centre hospitals nationally. In the next couple of years we also aim to further develop and improve care of ACS patients by improved patient pathways and patient information, and by ensuring that we have systems that monitor the care of the ACS patient and the areas of improvement. As it is a programme there is no finish date and the programme will seek continuous improvement of ACS patient care into the future.