Heart attack patients who are taken to heart care centres directly survive longer

By Dr. Ananya Mandal, MDMar 4 2019

A large observational study was presented at the Acute Cardiovascular Care 2019 a European Society of Cardiology (ESC) congress. It has found that heart attack patients survive longer if they are taken to heart centres early. Most patients admitted directly to heart care centres were mostly older and male. This finding was interpreted as younger persons and women with symptoms of heart attack being missed by paramedics or patients themselves. The abstract is titled, “Inter-hospital transfer for primary PCI has worse outcome compared with direct admission to a heart attack centre: a study of 25,315 patients with STEMI from the London Heart Attack Group”.

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According to study author Dr Krishnaraj Rathod, of Barts Health NHS Trust, London, UK, “The age of first heart attacks is getting younger, one of the reasons is because of lifestyle habits. The average age in our cohort is no longer 60, but around 40 years and we even see patients in their 30s. Directly admitted patients were sicker but they were also older, indicating that paramedics may think heart attack is unlikely in younger adults. My message to them is ‘in cases of doubt, repeat the 12 lead ECG and consider speaking to the heart attack centre’.” He warned that younger people aged in their thirties and forties should not ignore their symptoms of heart attack. “Younger patients likely wait longer to call for help because if they have chest pain, heart attack is not the first thing they think of. If you are in any doubt, phone an ambulance,” he explained.

The study was conducted by the London Heart Attack Group and included 25,315 patients with ST-elevation myocardial infarction (STEMI). This type of heart attack needs immediate management with primary percutaneous coronary intervention (PCI) that can remarkably improve the survival in these patients. For these patients, the researchers looked at time to primary PCI, long term outcome of the intervention at a primary PCI hospital compared to management at another hospital. Patients with STEMI included in this study (2005 to 2015) were treated using primary PCI at eight primary PCI centres in London. The information regarding the procedure as well as the outcome were recorded in the British Cardiovascular Intervention Society dataset. Deaths due to any cause were obtained from the Office for National Statistics.

Results showed that 17,580 (69%) patients were admitted first at the primary PCI centres and 7,735 (31%) were admitted initially at other centres. The median time between call for an ambulance and primary PCI was 52 minutes longer for patients who were referred from other centres compared to those who came to primary PCI centres first. Thereafter all patients were followed up for an average of three years. Deaths were more common among those who had to be transferred from other centres (18.7%) compared to those who were taken to primary PCI centres first (17.4%). Results revealed that the risk of deaths due to any cause were 20 percent lower among those who were taken directly to the heart centres. Dr Rathod said, “Our findings indicate that the superior survival in patients admitted directly to a primary PCI hospital was because there was a shorter gap between calling for help and receiving treatment... All patients with STEMI should be admitted directly to a primary PCI centre within 90 minutes of diagnosis by electrocardiogram (ECG), which is done by ambulance teams. Yet in our study nearly one-third were taken to another hospital first, indicating that a STEMI diagnosis was not made until patients reached that hospital, and they then had to be transferred. However, it must be noted that the rates of transfer directly to a primary PCI centre were better in the later years suggesting better identification of appropriate patients by healthcare staff.”