A recent article in the Guardian implies that the treatment of heart attacks outside working hours is below an acceptable standard. It suggests that "the principle of 'office hours only' applies as much to emergency medicine as it does to your local fishmongers".
The article quotes a meta-analysis of heart attack patients published in the British Medical Journal. 48 studies published between 2001 and 2013 were pooled for analysis. Most data was old (pre-2005 and some even from the 1990s) and only two studies looked at UK patients. The researchers 'concluded' that worldwide mortality rates for heart attacks (STEMIs) were higher outside normal working hours (and that North Americans fared better).
How does this data apply to the treatment of heart attacks in the UK now? For details on how we treat heart attacks in the UK see my earlier blog here. The majority of STEMI patients in the UK are now treated by primary angioplasty, the gold standard of heart attack treatment, and the speed with which this has been successfully implemented is shown by this graph.
ALL patients in the UK regardless of their background, location, age and clinical condition receive an equal and excellent standard of heart attack care 24 hours a day, 7 days a week, and delivered by a consultant. A network of designated 24/7 regional heart attack centres in the UK ensures that ALL patients get the appropriate treatment as soon as possible (and yes, to all those outside the UK, it is free at the point of delivery!). This is ONLY possible because the NHS delivers truly universal healthcare across the country and NHS ambulances work closely with NHS heart attack centres 24/7 to deliver the best care for patients.
All this data is very carefully audited and available to the general public. The MINAP (Myocardial Infarction National Audit Project) 2014 report is available here. BCIS, the British Cardiovascular Intervention Society, produces annual public reports (see here). Again the UK is unique in the way it audits and publishes data of ALL interventional cardiology units.
The general public in the UK should know that if they have a heart attack, they will receive the best possible care (at the very highest of international standards) 24 hours a day, 7 days a week. Any suggestion in the media to the contrary is misleading at best and scaremongering at worst.
Vinod Achan
Vinod Achan is a Consultant Cardiologist and the Clinical Lead for Primary Angioplasty at the Surrey Heart, Stroke and Vascular Centre, Frimley Park Hospital NHS Foundation Trust. Frimley Park Hospital NHS Foundation Trust is an award winning 24/7 regional Heart Attack Centre, performing over 1000 coronary angioplasties a year and delivering emergency cardiac care to a population of one million people.
