A heart-warming start to 2016
It is good to start the new year with a really positive story.
It was 1964 when Charles Dotter performed the first angioplasty and used the catheter delivered stent to open blocked arteries and improve blood flow in a patient with arteriosclerosis in her leg arteries.
And now, over 50 years later, the University of Leeds has published the results of a 10-year study covering 300,000 patients across 84 hospital Trusts into the use of stents after a STEMI (ST-elevation myocardial infarction), that is a heart attack caused by a complete blockage of a coronary artery. These account for up to 2 out of every 5 of all heart attacks. The report received widespread coverage in the press, much of it negative, and which seemed to me to miss the point: 9 out of every 10 patients in England who have suffered this type of major heart attack are now receiving the most effective treatment available.
Emergency stenting treatment – more formally, primary percutaneous coronary intervention (or PPCI) – involves opening a blocked artery to restore blood flow to the oxygen-starved part of the heart. It has saved thousands of lives over the last 10 years. So surely worth celebrating?
Yes, but it does nonetheless raise the issue of the ‘lost’ 10%.
Treatment is a bit of a postcode lottery. The Leeds report found that heart attack patients are more than twice as likely to receive PPCI treatment in hospitals which operate round the clock on seven-day services. Survival chances further increase in patients offered this life-saving procedure within 90 minutes of arriving at hospital. And while over the course of the study the number of hospitals providing stents went up, today 43% of Trusts which offer the procedure are still unable to offer it round the clock.
The report also concluded that patients were 30% more likely to receive stents if they were treated by hospitals with more than five cardiologists trained in the procedure. Technology saves lives – but on-site medical professionals need to know how and when to use it to best effect.
So, we can celebrate the dramatic and positive impact the stent has had on many thousands of patients since it was first used, and the happy holiday season that many families celebrated together with a loved one who is still here because they had the PPCI procedure. But we should also remember the 1 in 10 patients who were not so lucky – disproportionately including patients with a previous heart attack, angina, heart failure, diabetes, or who were older – and their grieving families. We should still applaud the NHS’s achievements – but we must not be complacent. And so we are calling on the NHS to standardise its PPCI provision to ensure that instead of varying standards of provision, it provides enough properly resourced heart units across the country that offer PPCI all day every day, and so we can avoid this unnecessary loss of life.