MINAP report published: 11 years on - majority of patients receive primary angioplasty

1 September 2011

Eleven years since the start of the national clinical audit for the management of heart attack, the majority of patients in the UK have their damaged artery opened with a balloon catheter (primary angioplasty) rather than receive clot-busting drugs.  Figures from the tenth annual Myocardial Ischaemia National Audit Project (MINAP) show that in England this year the number of patients receiving primary angioplasty rose from 63% to 82%, in Wales from 22% to 30%, and in Belfast rose from 59% to nearly all patients - 99%.

Read the 10th Public Report here >>

MINAP is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and is run by the National Institute for Cardiovascular Outcomes Research (NICOR), part of the National Centre for Cardiovascular disease Prevention and Outcomes within the UCL Institute of Cardiovascular Science.

Heart attack is common and remains a major cause of death and ill health. Prompt and appropriate treatment reduces the likelihood of death and recurrent heart attack. Good treatment coupled with cardiac rehabilitation promotes full recovery. Primary angioplasty is the preferred treatment for heart attack if it can be provided promptly. Once a patient is recognised as having a heart attack, ambulance staff take the patient directly to the catheter laboratory of the nearest heart attack centre, often bypassing smaller hospitals and the Accident and Emergency (A&E) department.

MINAP also measures the time from arrival at hospital to receiving treatment, and the time from calling for professional help:

• This year 90% of eligible patients in England, 68% in Wales and 87% in Belfast were treated with primary angioplasty within 90 minutes of arrival at the heart attack centre.
• 81% of eligible patients in England, 75% in Wales and 90% in Belfast were treated with primary angioplasty within 150 minutes of calling for professional help.

As the number of patients receiving primary angioplasty increases, patients receiving the other treatment, thrombolysis (clot-busting drugs) decreases. Access to primary angioplasty is currently variable, with the percentage of patients in English cardiac networks that received primary angioplasty ranging between 5-93%. In 6 cardiac networks less than 50% of patients received primary angioplasty. In the 2 Welsh cardiac networks 2% and 32% of their patients received primary angioplasty. Of patients who received thrombolysis (clot-busting drugs):

• 68% of eligible patients received thrombolytic treatment within 60 minutes of calling for professional help in England; 53% in Wales. Thrombolytic treatment is not used in the Belfast hospitals.

There has been a year on year fall in the percentage of patients with heart attack that die within 30 days of admission to hospital.

Dr Clive Weston, Clinical Director of MINAP, said:

"During the past decade, MINAP has documented major changes in the care provided to people who suffer heart attack. What has not changed in that time is the commitment of individual clinicians, managers and administrators who, through their participation in MINAP, continue to promote the values of national clinical audit - to compare their performance against nationally-agreed best practice, and so to assure and enhance the quality of that care. The remarkable improvement in survival after heart attack bears testimony to their efforts."

David Geldard, patient representative for MINAP, said:

"This is the tenth Report and audit as to how the Health Services in England, Wales and Belfast manage heart attacks. It is a heady mixture of better, good and excellent. Those people who demand treatment of heart attacks in local situations should take special note that the safest and most effective treatment for heart attack is at the specialised and centralised heart attack centres, where the best resources, specially trained staff, and streamlined procedures are available 24 hours a day, seven days a week, all the year round. This report firmly and absolutely supports these developments.  MINAP is objective evidence that in the management of heart attacks in England, Wales, and Belfast, we are getting better and better. On behalf of all those poorly patients who were treated for heart attacks last year it is a pleasure to say, "well done indeed, and thank you so much to all those staff and their services that made it so".

Professor John Deanfield, Director UCL Centre for Cardiovascular Prevention & Outcomes and Deputy Cardiovascular Program Director, UCL Partners, said:

"Despite this being MINAP's tenth Public Report, there have been further exciting developments. MINAP is now part of the new National Centre for Cardiovascular disease Prevention and Outcomes (NCCPO) created at UCL. This will greatly assist with the conduct of innovative research on this unique data set drawing on the academic strengths of UCL. We are very excited about the opportunities that this will present and believe that MINAP together with the other national cardiovascular audits will go from strength to strength in this environment."

Read the 10th Public Report here >>

Visit the MINAP webpage >>

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