Report identifies areas for continued improvement in STEMI management

The National Office of Clinical Audit (NOCA) has published the Irish Heart Attack Audit National Report 2024, which presents data on 1,615 patients who experienced an ST elevation myocardial infarction (STEMI). The report was launched by Prof Ronan Margey, National Clinical Lead for the Irish Heart Attack Audit, at the NOCA Annual Conference 2026, which took place at the Royal College of Surgeons in Ireland (RCSI) as part of its Charter Week programme.

The event was formally opened by Jennifer Murnane O’Connor TD, Minister of State for Public Health, Wellbeing, and the National Drugs Strategy.

The report provides an updated national view of care for patients experiencing a heart attack and highlights where processes are working well, while identifying opportunities to strengthen the pathway further.

Primary percutaneous coronary intervention (PCI) is the internationally preferred therapy for STEMI, and the audit shows that once patients reach a PCI centre, outcomes remain in line with international standards. The report also notes that early recognition of symptoms, timely diagnosis, and efficient transfer pathways are key determinants of care.

KEY FINDINGS

• A total of 45 per cent of patients called for help within an hour of symptom onset, a decrease from 49 per cent in 2023.
• Early symptom recognition and appropriate action is key to faster treatment.
• Primary PCI was delivered to only 77 per cent of eligible patients, a declining trend from 86 per cent in 2017.
• Only 61 per cent of patients received primary PCI within the recommended two hours after a STEMI is diagnosed.
• In patients who first present to a non-PCI capable hospital, only 3 per cent achieved the 30-minute door-in door-out target for transfer to a PCI centre.
• 55 per cent of those arriving directly by ambulance to a PCI centre achieved the 30-minute door-to-balloon target.
• Smoking remains a major risk factor and causes heart attack at much younger ages – 36 per cent of patients presenting with a heart attack were current smokers, and smokers experienced a heart attack on average 11 years earlier than non-smokers.
• 90 per cent of patients had at least one cardiovascular risk factor. The most prevalent risk factors were hypertension (53%) and hypercholesterolaemia (44%).
• 91 per cent of patients had an appropriate secondary prevention medication bundle prescribed, an increase from 86 per cent in 2023, and achieving the target of 90 per cent.

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, as well as shortening door to balloon times.

Prof Margey said “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.”

The audit also highlights the vital role of patient and public engagement in shaping improvement. Paula Connor, a cardiac patient and member of the Irish Heart Attack Audit Governance Committee, shared her personal experience to raise awareness of how symptoms can present differently, particularly in women.

“I was only 44 when I had my heart attack, and I didn’t realise what was happening. I just felt faint and had pressure in my arms. I was lucky to get help quickly and receive life-saving treatment. My message is simple, don’t ignore unusual symptoms and call 112 or 999 straight away. Acting fast can save your life.”

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