Just 61 per cent of patients who suffered a major heart attack in 2024 received the preferred treatment within the recommended two hours after diagnosis, a new report has found.
Timely primary percutaneous coronary intervention (PCI), which involves inserting a catheter into an artery, is recognised internationally as the preferred treatment for a major heart attack.
However, 77 per cent of all eligible patients received this treatment in 2024, including some who received it outside the recommended two hours, continuing a downward trend from 86 per cent in 2017, according to the National Office of Clinical Audit’s 2024 countrywide analysis on heart attacks. Published on Tuesday, the audit presents data on 1,615 patients who experienced a major heart attack.
Patients who received timely primary PCI had an unadjusted mortality rate of 4.1 per cent, compared with 7.4 per cent for those who did not.
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How patients access care initially may account for the fall in PCI delivery, according to the report, which says 24 per cent of patients self-presented to a non-PCI-capable hospital in 2024.
Primary PCIs were performed on 57 per cent of patients who initially presented to such a hospital, compared with 87 per cent of those who presented directly to a PCI centre.
However, the recommended goal for patients who initially present to a non-PCI-capable hospital and are then transferred by ambulance to a PCI centre within 30 minutes was achieved in just 3 per cent of cases.
Another contributing factor was patient delay in seeking medical attention, with an increase of 176 patients for whom such treatment was deemed inappropriate due to late presentation.
Among those patients, 86 per cent (152) called for help or arrived at a hospital more than 12 hours after symptoms presented.
Of the total number of patients who called for an ambulance, just 45 per cent (402) did so within 60 minutes of symptom onset, down from 49 per cent in 2023.
The figures underscore the need for a targeted public awareness campaign to educate on recognising symptoms and the importance of seeking “immediate care at an appropriate hospital”, the report says.
Such a campaign, however, could result in increased calls to the National Ambulance Service (NAS), potentially placing “additional pressure on existing resources”.
The NAS should be supported to assess the service impact of such a campaign and to identify required resources to meet demand, the report recommends.
The audit makes four national recommendations, including optimising the use and timeliness of primary PCI and supporting hospitals to review local processes that influence early diagnosis and faster transfer times.
Prof Ronan Margey, national clinical lead for the Irish Heart Attack Audit, said the system is “most effective when every step, from recognising symptoms to calling for help, diagnosis, transfer and treatment, happens without delay”.
The audit found that 36 per cent of patients presenting with a heart attack were smokers. It reported that smokers, on average, experienced a heart attack 11 years earlier than non-smokers.
Hypertension (53 per cent) and hypercholesterolaemia (44 per cent) were the most prevalent risk factors.
Dr Colm Henry, chief clinical officer of the HSE, welcomed the report, saying there are “improvements to be made”.
He said an action plan has been developed to address the report’s findings, which includes new primary PCI groups in each of the six health regions.
A number of other proposals will be implemented, he said, including developing new protocols to ensure 95 per cent of patients presenting to emergency departments with chest discomfort have an ECG within 10 minutes.
Protocols to reduce delays in calling for an ambulance to transfer a patient from a non-PCI hospital to a PCI centre will also be developed, alongside the development of a public information campaign.
