Number of patients receiving angioplasty is rising, heart attack audit shows

More than one in five patients in England and Wales who have acute myocardial infarction are receiving angioplasty as their first line of treatment (primary angioplasty), the latest figures from the myocardial ischaemia national audit project show.

But “effective communication” between referring hospitals, ambulance services, hospitals doing the angioplasty, and primary care is needed for further improvement to be made, its authors say.

The audit, now in its seventh year, measures how quickly hospitals and ambulance services have carried out primary angioplasty or thrombolytic treatment in patients who have had a heart attack.

A call in 2006 by Roger Boyle, the national clinical director for heart disease and stroke, to prioritise angioplasty has led to more trusts using it, particularly in some areas, such as London and Birmingham and the Black Country, the audit shows.

In England, the results for 2007-8 show that 54 hospitals carried out angioplasty instead of giving the patients thrombolytics, whereas the year before the number was 35. This meant that 4472 patients were treated with primary angioplasty in 2007-8, a rise of 42% on the 2006-7 figure of 3148.

However, 17 hospitals performed fewer than 10 angioplasties, and seven of the 30 English cardiac networks reported that they had restricted access to primary angioplasty services. Many are only now starting primary angioplasty programmes, and services are offered only during business hours, the audit said. Others perform angioplasty only when thrombolysis is contraindicated.

In Wales, the situation was worse, with only two hospitals performing primary angioplasty. Fifty three patients were treated with this procedure, compared with 44 in 2006-7.

Angioplasty and thrombolysis are both most effective when carried out within three hours of the onset of symptoms. The audit found that more than 60% of patients were treated in this time, with 79% of patients in England receiving angioplasty within 90 minutes of arrival at hospital.

The speed of administering thrombolytic treatment has risen, with more paramedic teams being trained in the procedure. Nearly three quarters (71%) of patients received thrombolytic treatment within 60 minutes of a phone call in England, up from 64% the year before. In Wales the figure rose from 42% in 2006-7 to 49%.

Greater numbers of trusts in both countries are also providing thrombolytic treatment to three quarters of eligible patients within 30 minutes of arrival at hospital: 90% this year in England (81% in 2006-7) and 36% in Wales (33%). Although in England safety may be compromised if trusts went further along this road, the audit said, Welsh trusts could improve.

Professor Boyle said, “In light of such good progress it is immensely rewarding to see the mortality rate for heart attack patients continue to fall. We are continuing with our efforts to reduce the number of heart attacks and to save more lives. The proposed vascular checks programme to be rolled out nationally from next year represents a further advance in our national strategy.”