How the NHS manages heart attacks: Seventh Public Report 2008 from the Myocardial Ischaemia National Audit Project (MINAP) finds that

• MINAP has collected data for eight years (2000–2008), and since it started has accumulated data on over 607,000 patients. It now receives data from all but one hospital that admit heart attack patients in England and Wales.

• Increased survival from heart attacks has occurred against a background of faster thrombolytic treatment in hospital, the introduction of pre-hospital thrombolysis and primary angioplasty and the improved use of secondary prevention medication.

• While there is variation between hospitals, most patients with heart attack are treated sooner after calling for professional help than in 2006/7.

• The use of secondary prevention medication has continued to exceed the national standards.

• The early treatment of heart attack patients has changed with the introduction of prehospital thrombolysis by ambulance services and the provision of primary angioplasty in an increasing number of hospitals.

• Improvement in thrombolytic treatment within 60 minutes of calling for professional help is the result of the increased use of pre-hospital thrombolysis by paramedics. Further improvement in call to needle time is dependent on further implementation of prehospital thrombolytic treatment in areas where there are long journey times.

• Hospitals and ambulance services have used MINAP data to improve systems for response to and recognition of heart attack patients and to provide treatment rapidly.

For patients the key messages are:

• The longest delay in the treatment of heart attack patients is usually the delay in calling for professional help.

• The earlier the treatment can be given the better the outcomes for patients.

• Patients should ring 999 for help immediately if the symptoms of a heart attack last more than 15 minutes and are not relieved by resting or using nitrate tablets or spray, if prescribed.

• Ambulance crews are trained to recognise the symptoms of a heart attack and treat cardiac arrest and thus patients who call 999 can be treated more quickly than those who make their own way to hospital.

• Most hospitals and ambulance services will have a Patient Advice and Liaison Service that should be able to give advice on your hospital’s and ambulance service’s performance.

• NICE has recently published guidelines for the longer term treatment of people who have had a heart attack which includes several recommended lifestyle actions (http://guidance.nice.org.uk/CG48). These include giving up smoking, being physically active for 20 to 30 minutes each day and eating a Mediterranean-style diet with more

bread, fruit and vegetables and less meat.