The number of patients brought directly by ambulance to a PCI centre following a heart attack decreased from 58% in 2021 to 55% in 2023, according to the Irish Heart Attack Audit National Report 2022 and 2023.
It found that there had been a reduction in the proportion of eligible patients who received reperfusion treatment and underscored the importance of timely treatment on mortality and long-term heart function.
The audit continued to show that the likelihood of achieving timely treatment was highly dependent on how a patient accessed a primary PCI centre. Patients who arrived directly at a PCI centre, usually by ambulance and after having the diagnosis confirmed by a pre-hospital ECG with the ambulance service, receives timely treatment in 79% of cases compared to 45% of those who were transferred from another hospital.
The report, launched by The National Office of Clinical Audit (NOCA) and presented by Dr Ronan Margey, National Clinical Lead of the Irish Heart Attack Audit (IHAA), revealed data on key quality indicators in the care provided to patients who experienced an ST elevation myocardial infarction (STEMI).
The report presents data from 3,102 patients treated in one of the ten primary percutaneous coronary intervention (PCI) centres in Ireland.
The most notable achievement was the increase in the proportion of patients referred for cardiac rehabilitation phase 3, which rose to 91% in 2023, up from 57% in 2022. Cardiac rehabilitation is a critical component of recovery for those who have had a heart attack, providing patients with structured exercise programs and educational support to reduce the risk of future heart events and improve long-term outcomes.
Capture of follow-up data has improved, and a risk adjustment model has been developed to report on mortality by PCI centre. In 2023, no PCI centre had a higher-than-expected mortality.
KEY FINDINGS
- 77% of patients with a STEMI were male with a median age of 62 years.
- Only 49% of patients called for help within one hour of onset of symptoms, an increase from 44% in 2021.
- In 2023, the median Door-In Door-Out (DIDO)* time was 97 minutes, and only 4% of patients with a STEMI achieved the DIDO target of 30 minutes or less.
- 35% of patients were smokers at the time of their heart attack, this is almost two times the rate of smoking nationally (18% in 2022). Current smokers present with heart attack on average 10 years younger than those who have never smoked.
- The proportion of patients who smoke and received smoking cessation advice increased to 91% in 2023, up from 80% in 2022.
- The proportion of patients prescribed appropriate secondary prevention medication on discharge increased from 75% in 2022 to 86% in 2023.
