Plan developed to address heart attack audit findings – HSE

The HSE has welcomed today’s publication of the Irish Heart Attack Audit (IHAA) report for 2024 published by the National Office of Clinical Audit (NOCA).  It provides a detailed review of the management and outcomes of patients treated for a major heart attack in Ireland under the Acute Coronary Syndrome (ACS) Programme in 2024, including their follow-up out to six months.

Over the last 10 years, more than 15,000 patients having a major heart attack (ST elevation myocardial infarction or STEMI) have been treated with immediate (primary) coronary balloon angioplasty/ stenting (percutaneous coronary intervention or PCI).

As a result, mortality from major heart attack has almost halved from about 7.4 per cent to 4.1 per cent, saving hundreds of lives.

The report confirms that the mortality rates for STEMI in Ireland are within the predicted range for the population based on age, sex and ethnicity. However it also highlights some areas for improvement and other important findings;

• Only 45 per cent of patients having a STEMI called 999 /112 within one hour of symptom onset, leading to a significant risk of both cardiac arrest and of worse long-term outcome if they survive.
• The percentage of patients undergoing primary PCI was 77 per cent when presenting directly to a primary PCI centre (down from 86 per cent in 2017). It was only 26 per cent in patients who presented to the emergency departments (EDs) of other hospitals.
• The ‘Door to ECG’ times in EDs is too long. Only 35 per cent of patients presenting with a STEMI to a PCI centre have an ECG within 10 minutes of arrival and this falls to 28 per cent in non-PCI EDs.
• Young people under 40 years of age who have a heart attack are three times more likely to be smokers (64 per cent vs 21 per cent) and women who smoke on average have a heart attack 13 years earlier than women who don’t smoke (61 vs 74 years of age).
• The ambulance transfer times of patients to primary PCI centres are too long and strategies to reduce these times including increasing the number of ambulances available need to be implemented.

Prof Ronan Margey, National Clinical Lead for the IHAA, commented: “This year’s report highlights the need for a renewed focus on public awareness, system-level process improvement and targeted risk factor management to reduce the incidence and improve the treatment of STEMI in Ireland. The system is most effective when every step, from recognising symptoms to calling for help, diagnosis, transfer and treatment, happens without delay. The findings support hospitals, the National Heart Programme, the National Ambulance Service and the wider system to target improvements where they will have the greatest impact.”

Dr Colm Henry, Chief Clinical Officer (CCO) of the HSE, said: “We welcome this report, its findings that mortality rates for STEMI in Ireland are as expected, and that outcomes for patients having a major heart attack have improved since the introduction of the ACS Programme in 2012. 

“We acknowledge there are improvements to be made and to that end, the HSE’s National Heart Programme has developed an action plan to address the report’s findings. This plan includes a proposal for the setting up of new regional primary PCI groups in each of the six health regions, in addition to the designation of University Hospital Waterford as the country’s seventh 24/7 primary PCI centre, as announced by Minister Carroll MacNeill in April 2025.”

According to the HSE, the National Heart Programme will work with the health regions, Office of the CCO, and other key HSE national functions, including the National Ambulance Service, to implement the following proposals:

• Increase in the number of ECG capable 24/7 ambulances staffed with emergency medical technicians trained to look after STEMI patients
• Development of a public information campaign to advise people who develop significant front of chest pressure lasting for more than 10 minutes and persisting, particularly if associated with sweating, left arm discomfort or shortness of breath, to call for an ambulance rather than present to their GP or nearest emergency room
• Development of new protocols to ensure that 95 per cent of patients presenting to an ED with chest discomfort have an ECG within 10 minutes
• Development of new protocols to reduce any delay in calling for an ambulance to transfer a patient from an ED in a non-PCI hospital to a PCI
• Optimisation of thrombolysis protocols with a target of thrombolysis within 10 minutes of a diagnostic STEMI ECG in the more remote areas of the country where transfer to a PCI centre within 90 minutes is not possible.
• Strengthen ongoing strategies to reduce smoking in light of this data demonstrating the significant association between smoking and the risk of STEMI in the Irish population.

Dr Henry thanked the NOCA IHAA team led by Ms Joan McCormick and Prof Margey for providing a detailed report, which provides the HSE with the information needed to improve the national primary PCI service.