New figures demonstrate encouraging outcomes and process in the quality of interventional treatment of heart attacks in the UK
Published: 13 Sep 2017
The latest report from the National Audit of Percutaneous Coronary Intervention (PCI) shows an increase from 26.9% to 80.5% in the use of a safer method of PCI (also called angioplasty, usually with stent insertion) between 2007 and 2015.
The PCI procedure, which involves inserting a tube or catheter into the patient’s arterial system to reach the blocked heart artery in order to improve blood flow, is associated with fewer complications if carried out through an artery in the wrist (the radial artery) rather than the femoral artery at the top of the leg. The significant increase has been seen in the use of this safer radial access procedure.
Peter Ludman, Consultant Cardiologist and Clinical Audit Lead said:
“The impressive increase in PCI procedures with radial artery access for the treatment of serious heart attacks ST-Elevation Myocardial Infarction (STEMI) shows that UK interventional cardiologists are keeping up to date with developments in their field and changing practice in response to evidence showing lower complication rates with this method.”
NICE quality standard [QS68] requires that patients presenting with ST-elevation myocardial infarction (STEMI, a major heart attack) receive emergency treatment within 90 minutes from arrival at a specialist heart centre. The audit, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme, found that 90.9% of patients being treated within that time frame in 2015, and this is similar to the standards achieved in the last 3 years.
Reasons for missing the 90 minute treatment target can be the result of initial admission to a non- specialist heart centre and consequent transfer between hospitals, or clinical reasons such as the requirement in some for further investigations to be undertaken before treatment.
Ensuring patients are treated by healthcare staff with sufficient expertise is fundamental to providing excellent care for cardiac patients. The 2005 guidance from the British Cardiovascular Intervention Society (BCIS) and the British Cardiac Society (BCS) therefore recommends institutions carry out a minimum of 400 of these procedures per annum (ppa).
The audit also reports on patients with unstable angina and non-ST elevation Myocardial Infarction (nSTEMI).). These patients are at risk of future cardiac events and require urgent but not immediate treatment. Although NICE quality standard [QS68] sets a target for treatment to be delivered to nSTEMI patients within 72 hours, about half of all patients are waiting longer than recommended. This is an avoidable cause of prolonged length of in-hospital stay and increased treatment cost. As with patients who have STEMI, treatment delays are worse for patients who require transfer to another hospital for PCI treatment.
Peter Ludman continued:
“The audit shows a reassuring picture of PCI quality in the UK. From 2014 to 2015 there was only a 0.5% increase in total PCI activity, bringing the total to 1,496 per million population (pmp). Primary PCI is established across most of the UK as the default treatment for ST elevation MI and most centres deliver this emergency treatment in a timely manner. Patients waiting for PCI having been admitted with a non-ST elevation myocardial infarct are still waiting much longer than recommended. However there has been a further increase in the use of the radial artery for vascular access, and overall outcomes from PCI remain good.”
Other messages in the report include:
- There remain long delays for patients waiting for PCI for non-ST elevation myocardial infarction, 2.5 days for those admitted direct to a PCI centre and 3.5 days for those initially admitted to another hospital.
- Overall outcomes following PCI remain good and unchanged from the previous year. Overall mortality was found to be about 2% to hospital discharge, and a stroke rate of 0.08%.
- The report has made important recommendations to address the access issues with plans for more direct admission to specialist centres for both STEMI and non-STEMI patients.