Hospital improves heart attack care
VICTIMS of heart attacks are receiving rapid access to life-saving medication at St George’s Hospital, according to a new report published by the Royal College of Physicians.
Figures from the Fourth Public Report of the Myocardial Infarction National Audit Project (MINAP) show 93 per cent of patients were given clot-busting drugs within 30 minutes of arriving at the Accident and Emergency department of the hospital in 2004/05 – a six per cent increase compared to the previous year.
In 2003/04, only 87 per cent of patients were given thrombolytic medication within half an hour.
Commenting on the figures, Dr Charles Pumphrey, Clinical Director of the hospital’s Cardiothoracic Unit, said:
‘We know that patients stand a much better chance of surviving a heart attack if treatment is given within an hour of them calling for help.
‘The sooner we give thrombolytic medication, the sooner we can restore blood flow to the heart and the more we can do to limit the damage inflicted on the heart muscle.’
Although the percentage of patients treated within 30 minutes has risen, the MINAP figures show a reduction in the number of patients that are given the medication within an hour of summoning help.
The ‘golden hour’, as it is dubbed by doctors, includes the time taken by ambulance crews to collect patients and take them to casualty.
Only 65 per cent of patients in 2004/05 were given the medication within an hour of calling 999, compared to 88 per cent in 2003/04.
Dr Pumphrey continues:
‘This is not an easy clinical target to achieve, especially when you consider the amount of congestion in the capital and the effect that has on the response times of paramedics.
‘We have forged a close and very successful partnership with London Ambulance to treat patients more quickly but the report clearly shows we need to do some more work with them to improve access to the drug, perhaps by reducing response times within our emergency department to give paramedics a little more flexibility.’
The hospital has improved the speed with which thrombolytic drugs are given by changing the medication that is used from a drip infusion to a one-off injection, and by establishing a dedicated area in the Accident and Emergency department where the electrical activity of patients’ hearts can be tested as soon as they arrive.
Sadly, thrombolytic treatment is not suitable for every patient, as Dr Stephen Brecker, the hospital’s Director of Cardiac Catheterisation, explains:
‘Thrombolytic drugs are effective for most patients but because the medication dissolves clots it’s not suitable for those at risk from internal bleeding.
‘In those cases, research shows that a surgical procedure called a primary angioplasty is much better for a patient, especially when they have delayed calling for help.’
The procedure, whereby a small balloon on the end of a catheter is inflated inside a blocked artery, was first made available as an emergency operation at St George’s Hospital 18 months ago. Since then, more than 40 patients from the local area have benefited from the procedure.
The hospital now wants to expand the service to make it available to patients from across South West London 24 hours a day.
At present, the emergency procedure is only available between 9am and 5pm.
This week, the hospital agreed a new clinical protocol for emergency angioplasties with London Ambulance paramedics that will allow patients suffering from a heart attack to be taken directly to the cardiac catheterisation suite when they arrive at St George’s, bypassing A&E and saving valuable time.