Report Highlights 'Time-Critical' Delay to STEMI Treatment

Priscilla Lynch 

March 12, 2021

Patients experiencing an ST-elevated myocardial infarction (STEMI) face ambulance delays that could impact on their ability to have life-saving treatment, according to a new national report by the Healthcare Safety Investigation Branch (HSIB).

Around 31,000 people have a STEMI annually in England, with a primary percutaneous coronary intervention (PPCI) being the preferred treatment. PPCI is most effective when conducted within 90 minutes of diagnosis.

National data show that in November 2019, the average time from 999 call to PPCI procedure was 137 minutes with 10% of cases averaging at least 191 minutes. By February 2020, the average was 132 minutes with 10% of cases averaging at least 179 minutes.

While thrombolysis is recommended as an alternative treatment to PPCI, the HSIB report identified a lack of evidence to suggest which treatment is best when delays occur and noted that thrombolysis is now rarely used as a pre-hospital STEMI treatment: The investigation found only 40% of English ambulance trusts now carry thrombolysis medication. Also, many paramedics are unlikely to encounter patients requiring thrombolysis.

The HSIB report concludes with three safety recommendations: two to NHS England and NHS Improvement and one to the Association of Ambulance Chief Executives (AACE). They focus on reviewing current guidance on timescales, clarifying information on STEMI treatment, and addressing the system factors behind delays.

Dr Stephen Drage, Director of Investigations at HSIB, said: "Delays in emergency response to STEMI’s and the impact this could have on treatment is a patient safety issue seen across England. Our investigation highlights that the reduced ability of the ambulance services to provide pre-hospital treatment places even more emphasis on patients arriving within a crucial time window to receive PPCI."

"Data cited in our report suggests that the longer the delay, the poorer the outcome could be even if patients survive the heart attack and the procedure that follows."

This article originally appeared on Univadis, part of the Medscape Professional Network.

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