This research used patient data to investigate the use of an emergency operation for heart attacks. 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. This involves the insertion of a small balloon on the end of a wire into the blocked blood vessel supplying the heart. Once in place, the balloon can be inflated to reopen the blocked blood vessel. The balloon is then deflated and removed, leaving behind a mesh tube, called a stent, which keeps the blood vessel open, allowing blood to flow 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.

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, very few 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 hospitals, for example more people received the procedure in 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?

The data came from the UK’s national heart attack register, the Myocardial Ischaemia National Audit Project (MINAP).

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. 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?

Using Data to Improve the Uptake of Life–Saving Heart Procedures in the UK

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