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Category Archive: MINAP

2015 MINAP Annual Report

Huge Improvement in Heart Attack Treatment, 9/10 of cases seen on time.

999 to treatment times improve by almost 40% in the last decade, according to national report.

The latest Myocardial Ischaemia National Audit Project (MINAP) report published today, has shown significant improvements in key indicators for heart attack patients, and also highlights the serious impact of smoking on the onset of heart attack.

Commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme, the MINAP audit reports on data collected from 217 hospitals, across England, Wales and Northern Ireland, in the 2014/15 period.

Wide reaching participation with centres in the audit provides us with an accurate representation of treatment of heart attack across the country, enabling NICOR to provide results that reflect the healthcare system as a whole, thus providing good clinical data that initiates quality improvement, to provide better patient outcomes.

Treatment for Heart Attack

Primary PCI (Percutaneous Coronary Intervention) has been established as best practice for re-opening the blocked arteries that cause a heart attack. 9 out of 10 patients that suffer a heart attack in England (99%) and Northern Ireland (92%), receive PCI treatment. In Wales 80% of patients receive PCI, up from 30% in 2010-11 as more centres establish PCI capabilities:

A key performance measure, ‘call-to-balloon’ time (CTB) is the interval between the call for professional help (ambulance) and the start of primary PCI treatment. The MINAP audit found that 89% of patients are treated with primary PCI within 90 minutes of arrival at hospital – the equivalent figure being 52% years ago (2004-2005).

Dr Clive Weston (Consultant Cardiologist & MINAP audit clinical lead) said:

“We have witnessed improvements in a number of aspects related to the quality of care for patients following a heart attack in recent years. That being said, there is still considerable scope for further improvement. Call to balloon times are generally reducing however, it would be great to see a reduction in the time taken for an ambulance to be called after that first noticeable symptom occurring. Educating the public on those early warning signs and how to react to them is the key.”

The report also addresses the health related risk factors associated with heart attacks. Unsurprisingly, smokers in the UK that experience a heart attack are, on average, over ten years younger than non-smokers.

“The average age at the time of heart attack is 57.9 years for male smokers compared with 68.1 years for men who have never smoked. The average age at the time of heart attack is 62.4 years for female smokers compared with 76.5 years for women who have never smoked.” MINAP 2014-15

Recommendations from the Report

The Myocardial Ischaemia National Audit Project (MINAP) measures the performance of hospitals that treat heart attack in the UK against best practice. The 14th annual report covers over 90,000 patient records, of which 83,842 had a final diagnosis of heart attack (myocardial infarction).

The MINAP provides valuable information on the performance of hospitals on an individual level while also having the scope to illustrate performance trends on a national scale. This wealth of data allows Medical Directors to identify areas for improvement, to effect change within their trust; while giving direction to CCGs and policy makers to implement initiatives on a regional or national scale, leading to better patient outcomes.

We should seek to create a dialogue with the general public, to increase the awareness of the risk factors for heart attack. But most importantly, to increase recognition of the early symptoms of heart attack so that care can be given sooner and a better outcome achieved.

To download the Annual Report and reports from previous years please go to this page:

MINAP Annual Reports

Clinical Services Quality Measures: Consultation Launches Today

The overall objective of the NICOR cardiac audits is to provide information to enable those who receive, deliver and commission healthcare to measure and improve services.

Clinical Services Quality Measures are one of the ways we will provide this information in a timely manner and will allow ‘at-a-glance’ comparisons of similar services across the country. The work has been commissioned by NHS England, and the cardiac measures will initially focus on the treatment of patient with hearts attacks.

We are currently in the development phase and have identified a long list of measures. These measures will be used to measure a quality service and aim to answer the following questions:

Patients: Clinicians: Answered by:
 Was I given the best care?  Did I do the right things?  CSQM measures based on good practice criteria or standards.
 Has my health improved?  Am I helping to improve survival and reduce morbidity?  CSQM based on life mortality and morbidity rates.

We would like your help to ensure we have the right domains and indicators to answer these questions.

What are the measures?

The CSQM spreadsheet* provides a full list of measures that cover both STEMI and NSTEMI patients.

*If you have any problems accessing the spreadsheet file, please access this link

These are separated into two worksheets to reflect the different patient pathways for Heart attack patients:

1) Primary Percutaneous Coronary Intervention (pPCI) Centres (centres that treat over 20 patients per year)

2) Non primary PCI centres or centres performing less than 20 cases per year.

If you would like to provide feedback on both the pPCI and nonPCI centres you will need to complete both surveys:

  1. primary PCI CSQM survey
  2. non primary PCI CSQM survey.

We would very much appreciate whatever you are able to do, while recognising that you are busy and have many demands on your time. Your input is very valuable.

The consultation closes on July 31st 2016.

  • Further information  about the CSQM programme can be found on the NHS England website.
  • A summary and FAQs for the Cardiac Clinical Services Quality Measures is available here.

MINAP Annual Report 2014

HEART ATTACK CARE – Mortality rates for STEMI fall by a third over 10 years as most patients with STEMI receive timely primary PCI, but only half of patients with nSTEMI achieve the NICE quality standard for timely angiography.

The 13th Public Report of the Myocardial Ischaemia National Audit Project (MINAP) contains information on 80,724 patients with heart attack and the care provided to them by 13 ambulance services and 212 hospitals in England, Wales and Northern Ireland, between April 2013 and March 2014.

Data published today shows that more patients having a STEMI heart attack have access to the nationally recommended treatment, within the approved target time.

Results also show that more patients are surviving these heart attacks. In the last ten years, the proportion of patients who have died within 30 days of their heart attack has fallen by a third: from 12.4 % (2003-04 ) to 8.1% in 2011/14. Mortality reported by MINAP is in agreement with that seen in clinical trials internationally, which suggests a very good standard of treatment for this type of heart attack in Britain.

More detailed analyses can be found in the full report :

Better Care, Better Outcomes

The experience of any patient suffering a heart attack can be described as a ‘pathway’, along which there are numerous opportunities to receive individual items of care. The provision of all these items, as a ‘bundle of care’, can be looked on as optimal treatment as described in Clinical Guidelines – recommendations that interpret or translate the results of research within carefully selected groups of patients into general clinical practice for all patients.

Clinical audits have tended to report the proportion of patients who receive individual components of care rather than on the proportion of patients who receive all the components for which they are eligible.

In their article published in European Heart Journal: Acute Cardiovascular Care, Simms and colleagues described 9 components along the pathway of care – some delivered in the early stages of treatment (before, or immediately on, arrival at hospital) and others delivered later on (by the time of discharge). They then defined, for each patient, a measure called the Cumulative Missed Opportunity for Care (CMOC), which represents the number of each of these nine components that were not provided. So for example, a patient receiving all components of care had a CMOC score of 0, while one receiving 7 of the 9 components had a CMOC score of 2.

Using the MINAP database, they calculated a CMOC score for patients discharged alive from hospital in England and Wales following ST-elevation myocardial infarction between Jan 2007 and Dec 2010. They performed sophisticated analysis to determine predictors of CMOC and the relationship between missed opportunities for care (CMOC) and the risk of death 30 days and 1 year after the admission to hospital.

Almost half of patients (44.5%) were judged by the admitting clinicians to be ineligible for one or more of the components of care. Of the remaining patients, who were eligible for all 9 components, half (50.6%) failed to receive at least 1 component. There was a clear relationship between higher CMOC (ie more missed opportunities for care) and higher death rates up to 1 year after admission. The authors also define a ‘domino-effect’ of missed opportunity, whereby failed opportunities to provide one of the early components of care was associated with subsequent failures to deliver one or more of the later components.

The authors call on clinicians to reduce their threshold for judging patients’ eligibility for treatment. Their study confirms the importance in routine clinical practice of delivering as many of the individual components of care as possible and suggests that outcomes for patients with heart attack could improve still further by adhering to guideline-recommended treatments.

Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study.

Simms at el. European Heart Journal: Acute Cardiovascular Care 2014. DOI: 10.1177/2048872614548602

MINAP and National Heart Failure Audit Patient Reports

Cardiac patients and their families are set to receive a major boost in information about heart conditions with the launch today of the two major patient-focused reports covering heart attack and heart failure care.

These are the first-ever patient versions of the annual MINAP (heart attack care) and National Heart Failure Audit reports and have been written in collaboration with patient representatives in an attempt to increase awareness of the audits, particularly in patients with cardiovascular disease and their families. It is hoped that this will empower patients and the public to question hospitals that fail to deliver high quality care, resulting in sub-optimal outcomes. Both audits have shown that patients who receive specialist cardiology care have better outcomes.

The reports condense the findings from the MINAP Annual Public Report 2011/12 and the National Heart Failure Audit 2011/12 Annual Report into shorter summaries and explain the purpose of the audits. Also included are straightforward explanations of the clinical concepts involved and these use everyday language than the Annual Reports.

The patient-friendly reports have been published MINAP and the National Heart Failure Audit are managed by NICOR (National Institute for Cardiovascular Outcomes Research), part of the Institute of Cardiovascular Science at UCL, and commissioned by the Healthcare Quality Improvement Partnership (HQIP).

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