Risk of heart attack death higher in some hospitals, study finds

A person’s chances of survival following a heart attack vary depending on which Irish hospital the patient is treated in, new research shows.

The National Healthcare Quality Reporting Systems report shows some Irish hospitals have a higher mortality rate for heart attack victims than the national average of 5.29 per 100 cases.

Bantry General Hospital in West Cork had the highest mortality rate for heart attacks between 2016-2018 at 8.93 per 100 patients within 30 days of admission, followed by Portiuncula University Hospital in Galway where the rate was 8.53 and University Hospital Kerry at 7.21.

Mortality rates among heart attack patients in St Vincent's University Hospital (6.88), University Hospital Waterford (6.85), Our Lady of Lourdes Hospital in Drogheda (6.40), the Mater hospital (6.32), St James's Hospital (6.07) were also above the national average.

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The lowest mortality rates were found in Our Lady's Hospital in Navan (1.56) and Wexford General Hospital (2.74).

There are many reasons for these varying rates of mortality following a heart attack, according to the report. Some hospitals may have a higher or lower number of patients with other medical conditions while there can be differences in access to medical care before arriving at the hospital, it says.

The quality of care delivered in different hospitals, inconsistencies in the quality of data gathered and the transfer patterns of patients between different hospitals may also play a role in the rates presented in the report, it added.

As a result, it cannot be concluded that a high mortality rate is indicative of poor quality care, it says.

Stroke mortality

The report also shows that stroke mortality rates are now at their lowest level in Ireland.

It shows the total number of people who died in the 30 days following hospital admission for a heart attack dropped by nearly a third between 2009 and 2018 while in 2015, the average rate of mortality because of a heart attack was lower than the OECD average.

The report also shows the mortality rate within 30 days of a patient suffering a stroke has fallen by 16 per cent over the past decade.

Stroke is the leading cause of morbidity and mortality in Ireland with more than 7,000 people in Ireland hospitalised following a stroke each year. Around 2,000 people in Ireland die as a result of a stroke each year.

Improvements in the health system highlighted in the report include increased screening rates for the CPE superbug, which is resistant to most and sometimes all available antibiotics. The number of CPE cases has increased year on year since it was first dictated in Ireland in 2009, with the number of cases almost doubling in 2016 and increasing by a further third in 2017.

There was also an improved uptake in bowel cancer screening which is the third most common type of cancer in Ireland with an estimated 2,270 cases each year. BowelScreen, the State’s national bowel screening programme which is currently available to men and women aged 60 to 69, is expected to expand until all of the 55-74 age group can be reached.

C-section

The caesarean section rates continue to rise each year with 31.4 per 100 live births being carried out through c-section in 2016, above the OECD average of 27.7.

The highest rates of c-sections were found in Cavan General Hospital, St Luke's General Hospital in Kilkenny, Mayo University Hospital, Our Lady of Lourdes Hospital in Drogheda and Portiuncula University Hospital in Galway.

The report warned that flu vaccine uptake rates among over 65s and healthcare workers is still not meeting national targets while the department expressed concern that Ireland reported the highest rate of chronic benzodiazepine prescription use in the OECD among older adults. The national uptake of the MMR and Meningitis C vaccines also remains below target.

Commenting on the report, Minister for Health Simon Harris said vaccination hesitancy, which he describes as "one of the greatest threats to public health today," needed to be addressed.

The minister also underlined as a problem the high use of antibiotics in hospitals and the chronic use of benzodiazepine among people aged 65 and older.

Professor Anthony Staines from the Department of Nursing and Human Sciences at DCU warned that it was difficult to ascertain the main issues in Irish hospitals given the incomplete system of reporting used to review the health system.

The age of the local population, resources in specific hospitals and how patients present all play a role in explaining the variations in mortality in different hospitals among heart attack patients, he said. Records of re-admissions rates would offer a fuller picture of treatment patterns, Prof Staines told RTÉ’s Morning Ireland. –Additional reporting from PA