Deaths linked to failures in cardiac care provision
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A number of newspapers have recently reported on the shocking finding that thousands of heart attack-related deaths in the UK could have been avoided. It is suggested that guidelines recommended by the European Society of Cardiology for the management of heart attacks are not being followed, resulting in avoidable death in up to 30% of cases.
The story relates to individuals suffering from Non ST elevation Myocardial Infarction or 'NSTEMI'. An NSTEMI is a heart attack where the individual has the symptoms of a heart attack with associated raised cardiac enzymes on blood testing, but they don't have the typical signs of heart attack ('ST' wave elevation) on an ECG. This is because the blood supply to the heart via the coronary arteries is only partially, rather than completely, blocked. This means that a relatively smaller area of heart muscle is damaged. That said, NSTEMI is still a serious medical emergency requiring acute and long-term management.
The study, funded by the British Heart Foundation and the National Institute for Health Research (NIHR), reviewed data from the UK National Heart Attack Register over the last 10 years to see whether guidelines, issued by The European Society of Cardiology (2015) for the care of patients who have had (NSTEMI) are being followed. The study looked at almost 390,000 people who had an NSTEMI and found that around 87% of patients did not receive one or more internationally agreed recommended interventions. Further, it was estimated if all patients had received all of the interventions, that around 30% of deaths may have been prevented over the 10 year period.
It is worth noting among the recommendations, as well as definitive medical investigations and treatments such as ECG, echocardiogram and the prescription of medication, that patients should be offered lifestyle advice including stopping smoking, healthy diet changes and general healthier living advice. Indeed, the study found that advice regarding stopping smoking and dietary advice were the top two recommendations most frequently not given. The outcome of such recommendations, even if offered, are of course entirely dependent upon the individual and, being given such advice in no way guarantees that all individuals will take it on board.
This story should certainly act as a wake-up call for primary and secondary health care providers to review their policies and procedures; any avoidable deaths is too many. It is a positive step also that the public should be made more aware of what they should expect from their health care providers should they be unfortunate enough to suffer a heart attack. However, I believe the limitations and finer details of this study should be considered before drawing wider conclusions.
To view a balanced article about the findings of this study and related issues, read more here.
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