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24 June 2009: This year's results from the Myocardial Ischaemia National Audit Project (MINAP) show that nearly half of heart attack patients are receiving primary angioplasty rather than thrombolytic (clot-busting) drugs. Primary angioplasty is a medical procedure to re-open the blocked coronary artery causing the heart attack, and has better outcomes than thrombolytic drugs.

The MINAP project is commissioned and funded by the Healthcare Quality Improvement Partnership (HQIP) and run by the National Institute for Clinical Outcomes Research at the Heart Hospital, University College London. It collects data from all eligible hospitals and ambulance services in England and Wales - results are available on the Royal College of Physicians website.

In October 2008, the Department of Health announced that primary angioplasty would take over from thrombolytic drugs as England's first line of treatment of heart attacks. The number of hospitals that have performed primary angioplasty increased from 54 to 66 in the last year, although 14 of these hospitals performed less than 10 cases. In Wales two hospitals perform primary angioplasty.

This year's audit results show:

• In England in 2008/9 7,351 patients (47% of all receiving treatment) were treated with primary angioplasty compared with 4,035 27% in 2007/8, an increase of 82%
• In Wales in 2008/9 118 patients (12%) were treated with primary angioplasty compared to 42 in 2007/8, an increase of 181%
• However, 3/28 English cardiac networks and 1/3 Welsh cardiac networks still have restricted access to primary angioplasty services (less than 10 cases in 2008/9)
• In England 84% of patients were treated within 90 minutes of arrival at the interventional centre compared to 79% in 2007/8
• In England 79% of patients received primary angioplasty within 150 minutes of calling for help
• In Wales 74% of patients were treated within 90 minutes of arrival at the interventional centre compared to 57% in 2007/8
• In Wales 77% of patients received primary angioplasty within 150 minutes of calling for help

There is evidence that from about three hours after the onset of symptoms, primary angioplasty is significantly more effective than thrombolytic treatment in patients with heart attack. At present more than six out of ten patients with heart attack receive one or other form of treatment within three hours of the onset of symptoms. Those who take longer to be treated are mostly those who take a long time to call an ambulance or go to their GP or hospital.

The 2009 report is the eighth report since the project began in 2001, and shows steady improvement year on year:

• The speed with which patients receive thrombolytic treatment has been maintained
• In 2008/9, 71 % of English hospitals with their associated ambulance services, reached or exceeded the English national target (68%) for the delivery of thrombolysis within 60 minutes of calling for professional help, compared with 71% in 2007/8
• 82 % of hospitals in England provided thrombolytic treatment to 75% of eligible patients within 30 minutes of arrival at hospital compared to 90% in 2007/8. In Wales the percentage was 50% compared to 42% in 2007/8
• The high levels of prescription of secondary prevention medication has been maintained

Recommendations from the report to improve patient care:

• Improved access to primary angioplasty services where this is currently unavailable.
• For the majority of English hospitals significant reduction in the delay before thrombolytic treatment within hospital is unlikely without compromising safety. There is still room for improvement in Wales.
• Efforts should be directed to increase the number of patients in England and Wales who receive pre-hospital thrombolytic treatment, particularly where primary angioplasty is unavailable and long journeys to hospital are involved.

Dr John Birkhead, Clinical Director of MINAP, said: We are delighted to be able to present analyses that are more extensive and detailed than last year. They show continuing improvements in care for patients with heart attack, and, for those who may benefit from angioplasty or clot busting drugs, a continuing fall in 30 day mortality.

Professor Roger Boyle, National Director for Heart Disease and Stroke, said: "Primary angioplasty is the international gold standard of heart attack treatment. Today's report shows that the number of heart attack patients receiving this emergency care has increased rapidly by 80% over the past year - a fantastic achievement by the NHS. This means better outcomes for more patients and more lives saved. We expect still higher numbers of heart attack patients to be treated with primary angioplasty as the NHS continues the roll out of specialist services this year.

Heart services remain one of our top priorities and we are continuing to improve them all the time. We met the target to reduce deaths from cardiovascular disease by 40 per cent in people under 75 five years early and the mortality rate has fallen 44% in the last ten years"

Robin Burgess, Chief Executive of HQIP, said: "The Myocardial Ischaemia National Audit Project shows more clearly than any other the value of clinical audit in leading to measurable changes in care and treatment for patients. Without MINAP, these impressive year on year results would not be achieved.

"Because these data are collected, provider Trusts continue to strive to meet the highest standards of care. Even without the need for additional quality improvement techniques or approaches, the data on compliance is enough to motivate local clinicians and managers to act on the findings and strive to meet best practice standards".

Dr Clive Weston, Associate Director of MINAP, said: "The provision of a primary angioplasty service demands new patterns of working by ambulance services and groups of hospitals, with patients being admitted to a smaller number of more specialised hospitals. That this service is increasing so promptly demonstrates the willingness of clinicians to embrace and implement new techniques when there is evidence that patients are likely to benefit. We need to continue to monitor the management of heart attack to show that the former high-quality system of care, mainly based upon thrombolytic drug treatment, is replaced by an equally excellent system using primary angioplasty as the preferred therapy."

For more information, or to view the full report, click here.

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