An evaluation of cardiac services in four hospitals in Lancashire for patients with ischaemic heart disease

Abstract

The aim of this study was to develop and manage a system measuring and linking morbidity and mortality in relation to care provision for patients with myocardial infarction (MI) in four hospitals in Lancashire, UK. Five data sources were used;
Initially research nurses recorded hospital data from a pooi of some 5,000 patients, from which a sample was taken of 200 confirmed MI cases and 200 cases of patients suspected, but not eventually diagnosed as MI. Patients from this sample who agreed to co-operate provided data at six-weeks and six-months post infarction. A questiolmaire was also filled in by the GP at six-months post infarct. When appropriate Lancashire Ambulance records were obtained. These five data sets from the 400 patients sampled were collected and collated onto databases. Major findings to emerge from these data included: 1) There were systematic mis-recording of arrival times at hospital, making hospital-recorded 'door-to-needle' (arrival at hospital 'door' to receiving intra-venous thrombolysis 'needle') time questionable; 2) A high proportion (67%) of re-infarction hospital deaths were associated with the use of CA 2 channel blocking drugs (given in spite of adverse clinical consensus); 3) 52% of patients diagnosed with Left Ventricular Dysfunction by their OP at six-months post MI had not received thrombolytic therapy. It can be concluded from the sample that the total study will reveal many instances where the standard of cardiac care can be greatly improved, without necessarily incurring proportional cost.