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BHF research points to failures in heart attack care in England and Wales

Around 33,000 deaths could have been avoided if heart attack aftercare guidelines were followed, according to a study BHF funded looking at the frequency of missed opportunities to treat people after a heart attack.

A team of researchers from the University of Leeds and UCL, funded by donations and with support from the NIHR, used medical records and other patient data to analyse heart attack treatment over a ten year period. They found that the majority of people did not receive all the treatments or interventions outlined in the guidelines. The research suggests that this is costing lives.

Find out how important your medical records are to our life saving research.

Which treatments should people receive?

Someone suffers a heart attack approximately every three minutes in the UK, with nearly 200 people of working age dying every week of a heart attack in the UK.

Around half of people who suffer a heart attack delay seeking medical help for dangerously long periods. Find out the signs and symptoms here.

In this study, which was published in the European Heart Journal: Acute Cardiovascular Care, the researchers used the UK National Heart Attack Register to analyse 389,057 cases of the most common type of heart attack, non-ST elevation myocardial infarction (NSTEMI), in 247 hospitals in England and Wales between 2003 and 2013.

The researchers looked at 13 treatments that guidelines recommend be considered for patients who have suffered from an NSTEMI, where blood supply to the heart is limited rather than completely cut off. They assessed how often these treatments were given and compared this with whether guidelines at that time suggested that they were appropriate.

Almost 87 per cent of patients did not receive at least one of the interventions that they should have been given. The most frequently missed were dietary advice, advice to help people to stop smoking and the prescription of a type of anticlotting drug known as P2Y12 inhibitors, such as clopidogrel.

What were the effects of missed treatments?

The team also looked at the effect that these missed interventions had on the health of the patients within the study. They concluded that some treatments had more impact on patient survival than others.

Heart attack patients who should have been given a coronary angiogramcardiac rehabilitation, advice to help them stop smoking or a prescription for statins but were not, had the highest risk of death.

Dr Chris Gale, Associate Professor of Cardiovascular Health Sciences at the Leeds institute of Cardiovascular and Metabolic Medicine, who led the research, said: "What we've highlighted here is the unacceptable deficit in the care being given to people after they've had an NSTEMI heart attack. We calculate that roughly one patient per month per hospital in England and Wales is losing their life as a direct consequence of this deficit.

Earlier this year the team showed how important stenting is for heart attack survival.

Using these findings to improve care

Research like this can be used to improve care for people who have had a heart attack and save lives. Dr Gale added: "The good news is that now we've identified the problem, we can certainly fix it. Simple interventions, such as prescribing statins, are being missed and this is resulting in loss of life."

BHF’s Medical Director, Professor Peter Weissberg, said: "Over the years the BHF has invested millions of pounds of donated money on research that demonstrates how best to identify and treat people who have had a heart attack. Hospitals need to apply the lessons learnt from this research and we're committed to working with the NHS to improve patient care."

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