Majority of people who suffered a heart attack had more than one risk factor  

The Irish Heart Foundation has called for the development of a new cardiovascular strategy with a lead unit situated in the Department of Health.

The Foundation made the call in response to the publication of the Irish Heart Attack Audit 2017-2020, which was launched today (Wednesday 20 April 2022) by the National Office of Clinical Audit (NOCA).

There are approximately 6,000 people with heart attacks admitted to Irish hospitals every year. Approximately, one-quarter of these patients suffer a major heart attack, known as an ST-elevation myocardial infarction (STEMI).

According to the findings of the Irish Heart Attack Audit National Report 2017-2020, the majority or 75 per cent of patients who suffered a heart attack had more than one risk factor for the cardiac event.

While high blood pressure and high cholesterol were the most common risk factors for heart attack identified, active smoking remains disproportionately high in people admitted with a STEMI, the audit found.

The audit revealed that 34 per cent of patients with a STEMI were active smokers at the time of their heart attack.  This compares to an average national smoking rate of 17 per cent in the general population.

The majority (64%) of heart attacks in younger people aged under 40 years occurred in active smokers. Smoking causes heart attack at a much younger age (median age among males: 56 years for smokers versus 65 years for non-smokers; median age among females: 60 years for smokers versus 76 years for non-smokers).

The Irish Heart Attack Audit 2017-2020 made a number of recommendations including, the need to “improve public awareness on the impact of smoking on heart attack risk,” and to “improve the identification and control of cardiovascular risks.”

It also recommended the development of “a public awareness campaign to encourage people with symptoms of heart attack to ring 112/999 immediately for emergency help.”

Dr Angie Brown, Medical Director of the Irish Heart Foundation said, “The Department of Health’s Changing Cardiovascular Health: Cardiovascular Health Policy 2010 – 2019 established a framework for the prevention, detection and treatment of cardiovascular diseases, to reduce the burden of these conditions.

“However, it has lapsed and unfortunately it has not been replaced with an updated policy, even though it covered prevention, clinical management of cardiovascular disease and all aspects of healthcare – from childhood through old age, from pre-hospital emergency care to rehabilitation and palliative care. The plan is now out of date and no formal review of the policy and the implementation of its recommendations has taken place.

“The scope and parameters of the current National Cardiac Services Review do not include a full and holistic approach to cardiovascular health, so preparations must begin for the development of a new Cardiovascular Health Policy, with a lead unit in the Department of Health.

“A critical part of this new policy should be an increased focus on prevention and early diagnosis, as had been the case in the previous policy. We can see from the findings of the report, the need for a comprehensive and focused campaign on prevention and awareness, particularly around the symptoms of heart attacks as well as the risk factors particularly smoking,” Dr Brown, added.

A heart attack is a serious medical emergency however the audit revealed that only 37 per cent  of patients with a STEMI sought medical help within 60 minutes of onset of their symptoms.

A key message from this report therefore is the importance of calling 999/112 as soon as someone experiences any symptoms of a heart attack. This ensures that they receive timely treatment.

Speaking at the launch of the report Michael Madigan, patient representative, heart attack survivor and  member of the Irish Heart Foundation Heart Support Network said,  “My decision to call 999 immediately when I was having a heart attack and the decision of the Paramedics to transfer me from my home in Cavan by Air Ambulance to the Mater Hospital saved my life. They were able to identify that I was experiencing a STEMI and directed me to the closest PCI centre at the earliest possible opportunity. I owe my life to those Paramedics and the PCI team. I will be forever grateful to them, the CCU team at Cavan General Hospital, the Heart Failure Nurses, the Cardiac Rehab team, the Mater Hospital Heart Failure team, my GP and Pharmacist and the Irish Heart Foundation who enabled and continue to support my recovery.”

OTHER KEY FINDINGS FROM THE IRISH HEART ATTACK AUDIT 2017-2020

• The majority (78%) of STEMIs occurred in males. The median age of patients with a STEMI was 63 years, with females typically presenting at a much older age (median age of 69 years for females versus 61 years for males).
• 84% of patients brought directly by ambulance to a PCI centre arrived within the 90 minutes or less target, however, only 22% of patients who were transferred from another hospital to a PCI centre arrived within this target.
• 81% of patients who were brought by ambulance to the PCI centre bypassed the Emergency Department and were brought directly for primary PCI treatment.
• In patients brought directly to PCI centres by ambulance, the median time between diagnosis of a heart attack and treatment with primary PCI was 84 minutes compared to 155 minutes for patients transferred from another hospital (target is equal to or less than 120 minutes).
• 85% of patients who were smokers received advice on how to quit smoking (90% is the national target).
• 71% of patients were referred to cardiac rehabilitation (90% is the national target).