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Specialist care cuts heart deaths

5 June 07 07:31 GMT

Swift treatment to re-open the arteries at a specialist centre significantly increases the chances of surviving a heart attack, a study has found.

Doctors at Harefield Hospital found under 3% of patients treated with angioplasty at the specialist heart centre had died after 30 days.

But of those patients taken first to a general hospital before referral to the centre, more than 10% died.

The study was presented at a British Cardiovascular Society Conference.

The British Heart Foundation estimates that 230,000 people in the UK have a heart attack each year, and that about 30% of these are fatal.

Dr Miles Dalby, a consultant cardiologist at Harefield Hospital, and colleagues looked at 180 patients who received direct primary angioplasty at their hospital.

Fast treatment

The patients were taken there directly by ambulance staff trained to identify patients who would benefit from the treatment.

Dr Dalby says patients at the hospital's heart attack centre receive treatment and have their blood flow restored within an average of 24 minutes after arrival.

They compared these with 181 patients who had received the treatment after being referred to the centre from a general hospital.

Cardiologists perform primary angioplasty to clear blockages in the heart's arteries - the artery is unblocked using a thin tube, then opened by inflating a small balloon, and held open with a metal tube, or stent.

In non-specialist centres treatment is often by thrombolysis drugs which dissolve the blood clots, but the study found in patients treated with thrombolysis in the preceding two years, around 9% died.

Dr Dalby said prompt treatment is vital for effective primary angioplasty, and that taking patients directly to heart attacks centres could reduce the number of deaths "significantly."

He said: "During a heart attack, blood flow to the heart muscle is blocked which damages it.

"The sooner the patient receives treatment enabling the blood flow to return to the coronary arteries, the less damage occurs.

"This gives better long-term results - time is muscle."

More detail needed

Dr Clive Weston, associate director of Royal College of Physician's Myocardial Infarction National Audit Project, which collects data on heart attack patients, said the results were "quite remarkable".

However he warned that in rural areas, where it make take some time to travel to a specialist centre, methods such as delivering thrombolytic treatments in ambulances could be more effective.

And he said the data needed to be explored in more detail to check there were no biases.

Thrombolysis is very effective if delivered soon after heart attack symptoms develop.

However, as time passes, angioplasty becomes the more effective treatment.

And Dr Weston said another benefit of primary angioplasty was that it allowed to doctors to see more of the coronary anatomy so they could see what had caused the heart attack and help prevent future attacks.

Judy O'Sullivan, cardiac nurse at the British Heart Foundation, said: "The study published by the Harefield team shows promising results for recent advances in the treatment of heart attacks at such specialist centres."

She said in the future angioplasty was likely to supercede thrombolysis as the treatment of choice for heart attacks,and added that patients' speed of response in dialling 999 could also affect their survival chances.

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