SPECIAL REPORT

Every seven minutes, someone in Britain will have a heart attack. They occur when the blood supply to the heart muscle becomes partially or completely blocked, and it’s always a life-threatening emergency. Around 50,000 men and 32,000 women have a heart attack each year, and about a third will die. In Scotland alone, around 25,000 people a year leave hospital having survived one.

The quality of care in the first few hours can mean the difference between life and death.

However, while survival rates have doubled since the Seventies, there are worrying signs of a growing gulf between care given to the most seriously ill patients at special cardiac centres and that given in A&E, where the majority of ‘walking’ heart attack victims end up.

The most serious kinds of heart attack occur when the blood supply to a section of the heart is completely cut off.

Symptoms are typically severe chest pains that radiate to the jaw, shoulder and arm, along with heavy sweating and breathlessness. Less severe heart attacks can have angina-like symptoms (chest pain or discomfort, nausea, dizziness) that come and go. However, all can be fatal.

Up to 33,000 deaths over ten years could have been prevented had the NHS followed its own guidelines for ‘walking’ heart attacks, according to a study published last week in the European Heart Journal: Acute Cardiovascular Care.

The guidelines set out what should be done during initial hospitalisation and when certain interventions should be carried out.

So an ECG (electrocardiogram) should be performed on admission in A&E or by paramedics outside hospital as soon as possible.

If a non-serious heart attack is then diagnosed, the patient should be prescribed beta blockers (unless they’re unsuitable). It’s also recommended the patient has an angiogram, where a dye visible on X-ray is used to check the movement of blood through the arteries — to help identify future risk of heart attacks — and is prescribed statins and offered referral for cardiac rehabilitation (exercise and information sessions).

But almost 87 per cent of patients in the study did not receive at least one of the interventions they should have been given in the first few days after their attack, putting them at greater risk of premature death.

‘What we have highlighted here is the unacceptable deficit in the care given to people after they’ve had a less serious heart attack,’ says lead researcher Dr Chris Gale, an associate professor of cardiovascular health sciences at the Leeds Institute of Cardiovascular and Metabolic Medicine.

It is ‘hugely concerning’ that many patients leave hospital without being prescribed cholesterol-lowering statins, says Martin Cowie, a consultant cardiologist at the royal Brompton Hospital and a professor of cardiology at the National Heart and Lung Institute, Imperial College London.

‘Lots of trials show that statins can help reduce the risk of further heart attacks, but this latest research suggests some people are going home without them.’ Professor Peter Weissberg, medical director of the British Heart Foundation, which part funded the new research, says: ‘Major heart attack patients are looked after extremely well by the NHS and there is a highly efficient standardised protocol for their treatment.’

For instance, someone having a major heart attack should have a procedure to insert a stent (a tube) to open up the blocked artery within 90 minutes. ‘However, less serious heart attack patients are falling through the cracks,’ says Professor Weissberg.

Paramedics are trained to pinpoint serious heart attacks by using an ECG — if this suggests the most serious form (because of a characteristic change in pattern), the ambulance is diverted to a cardiac centre where cardiologists are standing by to give immediate life-saving treatment.

There is a network of 51 cardiac centres throughout the UK. Glasgow is the main centre in Scotland, while there are specialist regional centres in Edinburgh, Dundee and Aberdeen.

But for less serious heart attacks, the ambulance goes instead to the nearest A&E. Professor Weissberg says: ‘When they get to A&E, they might not be treated by a cardiac specialist, and we know that people treated by cardiac specialists do better.’

Meanwhile, people who arrive at A&E under their own steam have to run the gauntlet of ensuring reception staff realise they should be a priority.

Elderly patients are particularly at risk because they may have multiple health problems and underlying heart attacks can be missed.

‘They may end up in a general or geriatric ward and not be seen by a cardiologist,’ says Professor Weissberg.

Just what a difference the treatment — and speed of treatment — can make for even ‘walking’ heart attack victims is illustrated in the two very different stories told here . . .