A ten year study of 300,000 heart attack patients, part funded by the British Heart Foundation (BHF) and led by the University of Leeds, has found rapid rates in the uptake of a treatment which improves a patient's chances of survival after they have suffered a major heart attack1.
The research, also part funded by the National Institute of Health Research (NIHR), showed the use of emergency stenting treatment (PPCI) increased from 0.1% in 2003 to 86% in 2013 for patients with STEMI - a heart attack caused by a complete blockage of a coronary artery which accounts for 25-40% of all heart attack cases in Europe2.
Despite such rapid uptake, the study found vast differences in the provision of PPCI treatment between hospitals, ranging from a 4 - 300% increase from 2003 to 2013. Recipients of the procedure are 37% less likely to die compared to those treated with clot busting drugs3.
The BHF says all patients having a STEMI should be taken to a designated heart attack centre with the facilities and staff to deliver round the clock PPCI, 7 days a week. And to ensure people do not miss out on the best available treatment, the emergency services need to improve their ability to identify heart attacks in patients who are chronically ill with multiple symptoms.
PPCI involves opening a blocked artery to restore blood flow to the oxygen-starved part of the heart and has helped save thousands of lives since becoming available in the early 2000's. Introduction of PPCI followed a ten-year action plan for heart disease (National Service Framework for Coronary Heart Disease) which prompted system-wide change and led to an increase in the number of hospitals able to deliver this lifesaving treatment.
However the research, published in the journal Heart, also found vast differences in the provision of PPCI treatment between hospitals, ranging from a 4 - 300% increase over the ten years. Patients suffering from diabetes, angina or having previously had a heart attack were less likely to receive the treatment (3%, 4% and 5% respectively), with chronic illness increasing the difficultly of diagnosis.
Living more than 30 kilometres from a hospital also lead to lower PPCI rates, but guidelines state that patients whose treatment with PPCI cannot be provided within 2 hours of arrival of the emergency services should receive clot busting drugs as an alternative. Other factors including the number of suitably trained cardiologists and an absence of round the clock availability of PPCI helped to explain 50% of the variation between hospitals.
However, the researchers say the remaining variation indicates differing standards of care across England and they believe all heart attack centres should have the facilities and infrastructure to be able to deliver this routine treatment round the clock.
Dr Chris Gale, BHF-funded researcher of the School of Medicine at the University of Leeds, said: "Emergency stenting has revolutionised the way we now treat heart attack patients and our research highlighted just how far we have come over the past ten years, with the vast majority of patients now receiving the best care.
"However it's clear that opportunities are being missed and in some cases treatment is simply not being offered. This is unacceptable and undoubtedly lives are being lost as a result.
"We need to ensure that services are adapted so doctors are able to recognise patients who need this potentially life saving treatment and hospitals are geared up to deliver it."
Professor Peter Weissberg, Medical Director of the BHF, said: "BHF-funded researchers first showed that a heart attack is caused by a blood clot blocking a coronary artery and that the sooner the blockage is opened, the greater the chances of survival.
"It is a testament to the NHS and its investment through the National Service Framework for Coronary Heart Disease that today nine in ten people who suffer a major heart attack in the UK are treated by PPCI. But clearly we need to do even better to guarantee all patients across the UK receive the best possible treatment.
"We need to ensure that the NHS provides enough, sufficiently resourced heart attack centres providing round the clock PPCI, to avoid needless loss of life."
The BHF continues to fund research to improve heart attack diagnosis and treatment, including a study which could reduce complications from stenting. Research like this is only possible thanks to donations from the public. At the BHF around 78p of every pound we raise is used to fight heart disease.
The BHF is calling on people to join the nation to Wear it. Beat it. on Friday 5th February. By wearing red and holding your own fundraising event you can help power life saving research to revolutionise the way we prevent and treat cardiovascular disease. Sign up online at www.bhf.org.uk/red.