Just over two in five people having a heart attack called emergency services within an hour of the onset of symptoms, a new audit has found.
It was “crucial” that the public be encouraged to call for help after recognising symptoms, an expert said, as the audit laid out four recommendations to improve outcomes.
On Wednesday, the National Office of Clinical Audit (Noca) published the Irish Heart Attack Audit National Report 2021.
The report made a number of key findings, including that only 44 per cent of patients called 999 or 112 for help within 60 minutes of symptoms beginning.
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Some 80 per cent of patients brought directly by ambulance to the primary percutaneous coronary intervention (PCI) centre, which is where patients requiring treatment for heart attacks are brought, arrived within the recommended time frame of 90 minutes.
Timely primary PCI was higher in patients admitted directly by ambulance to a PCI centre (82 per cent) compared with those transferred to a PCI centre from another hospital (41 per cent).
The unadjusted in-hospital mortality rate was 5.6 per cent. Timely treatment was associated with reduced mortality (3.5 per cent vs 5.1 per cent).
A total of 39 per cent of patients were smokers at the time of their heart attack, more than double the population rate of smoking (18 per cent). Smokers present with a heart attack nine years earlier than people who have never smoked.
Some 66 per cent of eligible patients were referred to cardiac rehabilitation, with the target being 90 per cent.
The audit makes four recommendations: to develop a public awareness campaign to encourage immediate calls for help upon presentation of symptoms; a national and regional focus on quality improvement in the care pathway; improve public awareness about the impact of smoking on heart health; and to increase the rate of referral to rehabilitation.
Common/typical symptoms of a heart attack include chest pain moving into the jaw, neck, arms or back; new shortness of breath. Uncommon/atypical symptoms of a heart attack include: unusual stomach pain; confusion; sweatiness.
In the foreword of the report, Dr Angie Brown, medical director of the Irish Heart Foundation, said it is “clear” that improved public health messaging encouraging patients to call 112 or 999 for help when they experience signs of a heart attack is “crucial”.
Pauline O’Shea, advocacy campaign manager at the Irish Heart Foundation, said she has “some real concerns” about the report’s findings.
“Public education regarding reacting promptly to possible heart attack symptoms, the importance of ambulance pre-hospital ECG diagnosis of STEMI heart attack, the significance of direct ambulance transfer for primary PCI and the importance of the timeliness of that treatment, through to outcomes for patients, could literally be costing patients’ lives and affecting survivors’ long-term quality of life,” she said.
“We also need to look at the shortfalls in service delivery this report reveals, as compared with the targets set. Heart attack is a huge issue in Ireland, so we really need to have good public messaging and education married with good service delivery to ensure we deliver best outcomes to patients.”
