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One care lapse can be fatal for heart attack patients

Comprehensive and timely care vital, study shows

Jo Carlowe

Monday, 15 September 2014

A single lapse in care can be fatal for heart attack patients.

New research*, led from the University of Leeds, reveals that patients who miss at least one of nine treatments for a heart attack have a 46% increased risk of death within a month of leaving hospital.

The study, led by Dr Chris Gale at the University of Leeds, also revealed a 74% increased chance of dying within one year if any component of care is missed.

The results are based on patients missing at least one of nine elements of care: pre-hospital electrocardiogram, acute use of aspirin, reperfusion, prescription of aspirin at hospital discharge, timely use of ACE-inhibitors, beta-blockers, angiotensin receptor blockers and statins and referral for cardiac rehabilitation after discharge from hospital.

Commenting, Dr Gale, said: “There is a clear relationship between the ability to provide comprehensive and timely care, and treatment and improved chance of heart attack survival.

“It is vitally important that healthcare professionals working in the heart disease field are made fully aware of, and trained in, these nine types of treatment so that the chances of saving a heart attack patient’s life are maximised. Many of these guideline recommended steps are straightforward, but for some reason they are not being provided. If more components of care are missed, the chance of dying increases further.”

Using one of the largest registries measuring heart attack outcomes, the researchers showed around half of about 31,000 heart attack patients discharged from hospital in England and Wales between January 2007 and December 2010 missed the opportunity to receive a potentially life-saving course of treatment.

Professor Peter Weissberg, medical director at the British Heart Foundation (which funded the research), said: “The study demonstrates the immense power of collecting ‘real world’ clinical data from doctors and their patients.

“The key message is that someone’s recovery from a heart attack is not solely dependent on any single element of the care pathway. This research shows the importance of ensuring all elements of care for heart attack patients are optimally delivered.

“By focusing on these findings, all centres should be able to improve further the outcome for their patients suffering a heart attack.”

The research also showed that hospitals with fewer specialist beds for heart attack patients were more likely to miss opportunities to deliver care. Hospitals with no specialist cardiology beds missed care opportunities 11% more often than hospitals with more than 50 specialist cardiology beds.

The research has been published in European Heart Journal: Acute Cardiovascular Care.

* Simms et al. “Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study”. European Heart Journal: Acute Cardiovascular Care

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