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Regional expansion of Primary Percutaneous Coronary Intervention (PCI)

Frequently Asked Questions

The Northern Ireland Programme for Government 2011-2015 stated a commitment to:

“By 2014-15, expand cardiac catheterisation laboratory capacity to improve access to diagnostic intervention and treatment and further develop a new primary percutaneous coronary intervention (primary PCI) service model to reduce mortality and morbidity arising from myocardial infarction (heart attack).”

• What is Primary Percutaneous Coronary Intervention (PCI)?

• What is happening in the regional expansion?

• What does this expansion mean for patients?

• When will the service be available in all areas?

• What are the benefits of primary PCI?

• What capacity does the designated centre in Belfast have to deliver the primary PCI service?

• What should people do if they suspect they are having a heart attack?

What is Primary Percutaneous Coronary Intervention (PCI)?

Heart attack, or Myocardial Infarction, is a leading cause of mortality and morbidity in Northern Ireland. A heart attack is said to have occurred when a heart muscle is damaged as a result of impaired blood supply. The amount of damage is greater when the blood supply to one of the heart’s arteries is cut off completely as a result of blood clot formation. This type of heart attack is called a ST Elevation Myocardial Infarction (STEMI) heart attack. Approximately 40% of hospitalised heart attack patients have a STEMI. High quality care for these patients includes early diagnosis and rapid treatment to reopen the blocked artery.

A STEMI heart attack has traditionally been treated by giving patients a clot-busting drug (thrombolysis). Patients will later go to a catheterisation laboratory (“cath lab”), over the next few days while in hospital to have a metal stent inserted to hold the artery open and preserve good blood flow.

Primary Percutaneous Coronary Intervention (PCI) involves the patient having a STEMI heart attack being taken straight to a cath lab to widen the artery, clear the blockage and immediately have a stent inserted to improve blood flow, rather than using clot busting drugs.

Primary PCI is accessed via direct admission to a designated centre with dedicated cath lab facilities capable of undertaking the procedure 24/7 hours a week and 365 days a year. In Northern Ireland, primary PCI will be delivered from two centres, one in Belfast and one in Altnagelvin. These centres give the greatest geographic coverage for the population of Northern Ireland. The Royal Victoria Hospital primary PCI Centre will cover 75% of the population and Altnagelvin Hospital primary PCI Centre will cover the remaining 25%.

What is happening in the regional expansion?

To date, a pilot project in Belfast’s Royal Victoria Hospital has been providing a primary PCI service on 24 hours a day/seven days a week basis within the Belfast Trust catchment area and this is now beginning to be rolled out to other areas.

On Monday 30th September 2013, the primary PCI service, delivered from the Royal Victoria Hospital, will expand to STEMI patients in the catchment areas of the Ulster, Downe, Lagan Valley, Antrim Area, Daisy Hill, and Craigavon hospitals along with those living in Ballycastle and Ballymoney.

The next phase of regional expansion is expected to be in place by summer 2014 when Altnagelvin Hospital will become Northern Ireland’s second primary PCI centre. Until then, services for patients who are not in the catchment area of the Royal Victoria Hospital primary PCI service will continue with use of clot-busting drugs followed by planned PCI before they are discharged from hospital.

What does this expansion mean for patients?

Patients do not need to do anything different. If they, or their relatives, think they are having a heart attack they should still dial 999.

Ambulance staff are trained to diagnose STEMI heart attacks, and if this is confirmed and the patient is in the catchment area for the new service, they will stabilise the patient and take them directly by blue light ambulance to the specialist primary PCI Centre at the Royal Victoria Hospital.

Patients who are not in the catchment area will be stabilised, given thrombolysis (clot-busting drugs) if clinically appropriate and taken to their local Hospital’s Cardiology Service as is currently the case.

Most heart attack patients are still encouraged to dial 999 as that will allow them to get treatment as quickly as possible. However, some do come directly to emergency departments; these patients will also be assessed and transferred as emergencies to the primary PCI centre if they are in the catchment area.

Most patients will remain at the Royal Victoria Hospital for six hours following their primary PCI and will then be transported by ambulance back to a Coronary Care Unit closer to their home.

When will the service be available in all areas?

Primary PCI is a very complex service and to deliver it safely requires a specialised team of cardiologists, nurses, radiographers and clinical physiologists to be available 24/7.

The Health and Social Care Board, Public Health Agency, Trusts and Northern Ireland Ambulance Service are working collaboratively to ensure the managed introduction of this service so that patients can be assured of the safe delivery and administration of this new treatment.

The regional primary PCI service is part of a bigger investment to expand cardiac cath lab capacity for a range of cardiac conditions, including complex arrhythmias. Some £8 million has been earmarked within Transforming Your Care (TYC) for the wider investment.

Plans are underway to establish a new cardiac catheterisation laboratory in Altnagelvin, which will be close to its Coronary Care Unit and more suitable to deliver primary PCI. This is expected to be complete by summer 2014, following which 24/7 primary PCI will be available for all clinically appropriate STEMI patients in Northern Ireland.

What are the benefits of primary PCI?

Current clot-busting treatment (thrombolysis) is an effective treatment but research on primary PCI has shown that it further improves survival. There are also fewer complications such as strokes and recurring heart attacks. Patients who have primary PCI stay a shorter time in hospital than patients who have thrombolysis.

What capacity does the designated centre in Belfast have to deliver the primary PCI service?

Of the patients who reach hospital following a heart attack, approximately 40% have STEMIs, with the remainder termed non-STEMI. Non-STEMI heart attacks do not require primary PCI.

It is estimated that there are approximately 950 STEMIs per year treated in hospital in Northern Ireland.

The RVH pilot for primary PCI has been treating just over 200 patients per year on a 24/7 basis.

From Monday 30th September, the primary PCI centre at the RVH will increase its capacity to deal with approximately 720 patients per year in total.

What should people do if they suspect they are having a heart attack?

If people suspect that someone is having a heart attack, they should continue to call for help using 999 as this is the best way to get to the right place for treatment quickly.

Health Minister’s announcement on the rollout of a regional primary PCI service for heart attack patients

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