Myocardial Ischaemia/MINAP (Heart Attack audit)

Introduction

The Myocardial Ischaemia National Audit Project (MINAP) is a domain within NCAP that contains information about the care provided to patients who are admitted to hospital with acute coronary syndromes (heart attack). Data are collected and analysed to illustrate the ‘patient journey’ from a call to the emergency services or their self-presentation at an Emergency Department, through diagnosis and treatment at hospital, to the prescription of preventive medications on discharge. Provision of care by staff practising in participating hospitals, and, where relevant, ambulance trusts, is expressed through clinically-important quality improvement/assurance indicators.

MINAP works closely with the British Cardiovascular Society (BCS) – the body that represents and supports those professionals who work in cardiology in the UK; BCS maintains close links with patients and carers of patients with cardiac disease, and with cardiac nurses and physiologists.

https://www.britishcardiovascularsociety.org/

Details of the MINAP dataset, including definitions of the variables and guidance on applying the various options, are available at https://www.nicor.org.uk/national-cardiac-audit-programme/datasets/

Contact details:

Project Manager: Samuel Perwaiz

Project Coordinator: Jane Kerr

nicor.auditenquiries@nhs.net

Summary Report 2023

Myocardial Ischaemia National Audit Project 2023 Summary Report

Key Messages document

Line of Sight table

Quality Improvement Themes (Hospital/Ambulance Trust level tables)

Reviewed by a cardiologist

Hospital Level Analyses:

Reviewed_by_a_cardiologist

Performance of an angiogram

Hospital Level Analyses:

Performance_of_an_angiogram

Case Ascertainment for Health Boards in Wales

Hospital Level Analyses:

Case-Ascertainment-for-Health-Boards-in-Wales_2021_22

Case Ascertainment for Trusts in England

Hospital Level Analyses:

Case-Ascertainment-for-Trusts-in-England_2021_22

Discharged on appropriate medications

Hospital Level Analyses:

Discharged-on-appropriate-medications

Timeliness of primary PCI by hospital

Hospital Level Analyses:

Timeliness of primary PCI by hospital

Timeliness of primary PCI by ambulance trust

Hospital Level Analyses:

Timeliness-of-primary-PCI-by-ambulance-trust

Performance of an Echocardiogram

Hospital Level Analyses:

Performance of an Echocardiogram

Referral to Cardiac Rehabilitation

Proportion of patients who were referred to a cardiac rehabilitation programme

Referral-to-Cardiac-Rehabilitation

STEMI & NSTEMI

Based upon electrical heart tracings – electrocardiograms or ECGs recorded during the index event, patients are diagnosed as having suffered either ST-elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI). The management of these two forms of heart attack are broadly similar, yet include important early differences. The Quality Improvement indicators reflect some of these differences.

In the annual NCAP report, the terms ‘higher-risk’ and ‘lower-risk’ have been used to differentiate STEMI from NSTEMI. Those with ST-segment elevation are most likely to have complete coronary occlusion and require primary angioplasty. Higher-risk heart attacks in the report therefore refer to STEMI – patients who are at high risk of substantial heart muscle damage or early death. Patients who do not have ST-segment elevation on ECG, who are likely to have only partially obstructing clots in the coronary artery and so do not need immediate angioplasty, are at lower risk of early death. Lower-risk heart attacks in the report therefore refer NSTEMI – though, because patients with NSTEMI tend to be significantly older and have more co-morbid conditions than those with STEMI, over a one-year period the risk of death is about the same in both groups.

Analysis

The current analysis is for heart attacks admitted to hospital during the 12 months between April 2021 and March 2022. Hospital and Ambulance Trust performance, with respect to a number of aspects of care, are presented in tabular form.