Although a type of care or treatment may be well-evidenced, this does not necessarily mean that all healthcare trusts and services adopt it or have access to it. This research used patient data to investigate variations in the use of an emergency operation for heart attacks across the NHS in England. The findings that uptake was not uniform across England can be used to inform improved care across the NHS to ensure that everyone receives the same quality of care.

Why was this work needed?

When someone has a specific type of heart attack, an emergency keyhole heart operation can save their life. A small balloon on the end of a wire can be inserted into the blocked blood vessel supplying the heart, which can then be inflated to reopen the blood vessel. Once this is deflated and removed, a mesh tube (stent) is inserted to keep the blood vessel open and the blood flowing freely.

Although evidence has shown this treatment to be effective and lifesaving, the speed at which it was rolled out across the NHS after its inclusion in medical guidelines was not known. It was important to determine the geographical and temporal variations in the adoption of this treatment, to identify specific groups for whom this treatment is less accessible.

What happened?

The researchers used data on heart attack treatment across England between 2003 and 2013 and analysed how many eligible patients were given this procedure over time. They found that at the beginning of the study and shortly after recommendation in medical guidelines, 0.01% of patients received the treatment but by 2013 the rate had risen to 86%.

What were the benefits?

Although far more eligible patients now receive emergency stents, the research also demonstrated variation between patients (e.g. older and sicker patients were less likely to receive the treatment) and between hospitals (e.g. more people received the procedure when they attended smaller hospitals and hospitals that had more doctors who specialised in heart conditions).

This research showed a dramatic improvement in the uptake of this treatment in ten years, but it also demonstrated where further improvements could be made. Work of this kind is vital to ensure that new treatments are being rolled out consistently across the NHS, so that all eligible patients can benefit.

What type of data was involved?

Anonymised patient data came from the UK’s national heart attack register, the Myocardial Ischaemia National Audit Project (MINAP). Data collected at each hospital are encrypted before being transferred to a central database for analysis.

MINAP is a comprehensive clinical database of patients who are hospitalised with a heart attack described as ‘acute myocardial infarction’ and is mandated by the Department of Health for all hospitals in England and Wales. MINAP is covered under section 251 approval, which allows the registry to collect identifiable patient data and does not require ethical approval under NHS research governance arrangements. However, all data was de-personalised before the researchers were given access.

Who funded and collaborated on this work?

The researchers conducting this work were funded by the British Heart Foundation and the National Institute for Health Research (NIHR).

Where can I go for more information?


Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013

Using anonymised data to compare how different cardiac rehabilitation services are performing in different areas and for different demographic groups