Developments within the National Ambulance Service such as vehicles equipped with specific ECG machines and paramedics been trained in their use and interpretation alongside the establishment of dedicated centres for cardiology teams in the pPCI have all resulted in a significant and positive change for patients in recent years.
Photo: (Health Minister Leo Varadkar at launch of new Ambulance Fleet)
‘The Heart Attack Care in Ireland 2014’ report found that 92% of appropriate patients received angioplasty compared with 55% in 2011, which according to HSE Director General Tony O’ Brien is a tribute to the co-operation and commitment between dedicated hospital teams and the National Ambulance Service.
The Health Service Executive has designated a range of centres across the country, through the Acute Coronary Syndrome (ACS) Clinical Programme, to deliver pPCI. Ambulance Paramedics are trained in STEMI heart attack recognition and a paramedic can speak directly with the pPCI centre through a dedicated freephone. A specific protocol has been agreed and implemented, which ensures that patients are brought to the most appropriate medical setting.
The gold standard treatment for a major heart attack (STEMI), is primary percutaneous coronary intervention (pPCI), commonly known as coronary angioplasty, as early as possible after the patient first experiences symptoms. pPCI usually involves the placement of stents to improve blood flow to the heart. If a STEMI heart attack patient cannot be transferred to a pPCI centre within 90 minutes, they will be transferred to the nearest Emergency Department to allow for thrombolysis to be administered.
International evidence has shown that pPCI intervention is most effective if the dedicated centre can be reached within 90 minutes of diagnosis. Professor Kieran Daly, Clinical Lead Programme for ACS, said “The aim of our programme, established over two years ago, was to save lives by standardising the care of these patients across the country. At 92 per cent, our high level of pPCI access compares favourably with other countries such as Wales (72%) and England (97%).”
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.
With plans for a new cross border service expected to be in place in the coming weeks, 90 per cent of the population nationally will have access to a pPCI centre within 90 minutes. A new service in the North West will also commence shortly featuring an innovative cross border service that will give Donegal patients suffering from a STEMI heart attack direct access to services in Altnagelvin Hospital in the North. It is anticipated that up to 60 patients a year will be treated in the Derry hospital.
Photo: (Professor Kieran Daly)
Prof Kieran Daly said “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; CUH; Galway University Hospital; the Mater; 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.