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STEMI treatment protocols saving lives – HSE

Speaking at the launch of the report Heart Attack Care in Ireland 2014, HSE Director General Mr Tony O’Brien said that, in 2014, 92 per cent of appropriate patients received angioplasty compared with 55 per cent in 2011.

Mr O’Brien said this significant change is a tribute to the “co-operation and commitment between dedicated hospital teams and the National Ambulance Service. This modernised approach puts Ireland on a par with our European neighbours.”

The gold standard treatment for a major heart attack – a ‘ST Elevation Myocardial Infarction (STEMI) – is Primary Percutaneous Coronary Intervention (pPCI) as early as possible after the patient first experiences symptoms.

The HSE, through the Acute Coronary Syndrome (ACS) clinical programme, has designated a range of centres across the country to deliver pPCI. According to Prof Kieran Daly, Clinical Lead for the ACS programme: “International evidence has shown that pPCI intervention is most effective if the dedicated centre can be reached within 90 minutes of diagnosis. The aim of our programme, established over two years ago, was to save lives by standardising the care of these patients across the country. And at 92 per cent, our high level of pPCI access compares favourably with other countries such as Wales at 72 per cent and England at 97 per cent.”

The establishment of dedicated cardiology teams in the pPCI centres allowing for the maintenance of a 24/7 service with direct access Catheter Laboratories has been an essential development.

Equally important have been developments within the National Ambulance Service. Their vehicles are now equipped with specific ECG machines and paramedics are all trained in their use and interpretation. Paramedics are also trained in STEMI heart attack recognition. Ambulance crews can speak directly with the pPCI centre through a dedicated freephone. A defined protocol has been agreed and implemented which ensures that patients are brought to the most appropriate medical setting.

If a STEMI heart attack patient cannot be transferred to a PPCI centre within 90 minutes, they will be transferred to the nearest hospital Emergency Department to allow for thrombolysis to be administered. Helicopter transfer for STEMI heart attack patients to the pPCI centre is also an option in certain areas, states the HSE.

According to Prof Daly, once a new cross-border service is in place in the coming weeks, 90 per cent of the population nationally will have access to a pPCI centre within 90 minutes. “We have been building this service over the last three years and this is a significant development. The small proportion of patients outside this 90 minute transfer time are also dealt with according to national protocols through thrombolysis and then transferred on an urgent basis to a pPCI centre. All international programmes face similar challenges but we feel we are succeeding in reaching a very high percentage of our population at present.”

The designated 24/7 centres are: St James’s Hospital, Dublin; Cork University Hospital; Galway University Hospital; Mater Misericordiae University Hospital Dublin; and University Hospital Limerick. University Hospital Waterford operates as a pPCI centre on a nine to five, Monday to Friday basis supplemented by a thrombolysis service out of hours.

A new service in the North West will commence shortly featuring an innovative cross border service that will provide Donegal patients suffering from a STEMI heart attack direct access to services in Altnagelvin Hospital, Derry. It is anticipated that up to 60 patients a year will be treated in the Derry hospital.

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