MINAP
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| 7-8 years ago the Department of Health delivered a National Service Framework document around Coronary heart disease. In chapter three, standards 5-7 are about the treatment of patients who are presenting with acute MI. As part of these standards it phased in treatment times in which every hospital within the United Kingdom had to aim for. The end result was that anyone calling for help, to either a GP, NHS direct, or calling 999, with symptoms of an acute MI, should receive thrombolysis within 60 minutes. Now this might not sound that unreasonable, however, on the ground this is a considerable task. Leicestershire does have some remote areas, and as we all know traffic at times can be heavy. As part of this national recommendation, pre-hospital thrombolysis was promoted, as it can and does speed up the whole process. Crew can deliver the treatment to the patient, rather than the patient being delivered to the nearest hospital ( it would be a like fire crew bringing the fire back to their fire station to put the fire out!) As a result we have seen a steady increase in the numbers that have been thrombolised in the community, and then brought in to the hospital. Although we have not seen the numbers we might like to see, for various reasons, in some areas this is almost now exclusively the main treatment method. |
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What are our current targets? Well we are currently looking to achieve 60%. Which means that of the entire group of patients which attend our hospitals over the next year, at least 60% should receive the treatment within 60 minutes. Every month we have a MINAP meeting, made up of Clinicians (Doctors), audit personnel, ambulance managers, specialist nurses and discus every patient who has received thrombolysis over the previous month. If you would be interested in in seeing how we are progressing this year please click here to jump to the current data tables.
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So why an hour? Research has been completed around this subject, and without doubt, the quicker you get the thrombolysis from the onset of pain, the better chance of survival you have and your long term health benefits, in fact within one hour and your chances are very good. By 12hrs, the benefits of thrombolysis are much less, and the risk of having the drugs (side effects) probably out weigh the benefit. Which is why we usually do not administer the treatment after this time (although we would still consider some people - e.g. on going pain). Time is muscle, so the quicker we react to treatment the less damage is done. |
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PCI (Primary Coronary Intervention) There is a growing body of evidence that PCI may have a better outcome. Patients are taken directly to the catheter labs, and the effected artery is opened with small balloons or stents. This service is available, but currently, only at the GGH site and mainly during "office" hours. Although should thrombolysis fail, rescue PCI can be performed outside these hours.
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What causes Coronary Artery Disease Coronary artery disease is complicated to manage, there are many factors which influence the disease process. Smoking, Diabetes, Obesity, Diet, Cholesterol, Hypertension, family history, physical activity all play their part in advancing the disease process. Which is why it is rare for at least one of these not to be in the news most days. Clearly as individuals we can reduce our own risk by modifying the those risk factors which are modifiable (i.e. give up smoking, take more exercise, watching what we eat)
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Age For many people the risk of having a heart attack was something which you might expect in your later years, 50+, however we are seeing increasing numbers in there late 20's and early 30's, some of whom have not smoked, and have no family history. So don't put off those life style changes! It is also important to consider this when you are dealing with adults who are in the age group. It is easy to exclude a cardiac event, "because he is only 28 years old" - this is no longer the case. We do find that early ECG is the key to early treatment.
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Copyright © 2006 Clot-Buster |
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