Dear Councillor Wootten,
In response to your letter dated 7 September, we believe it would be useful to clarify the current clinical treatments for the management of heart attacks in Lincolnshire, depending on how a patient presents.
In line with national recommendations, if a patient develops chest pain they should call 999. Patients calling their GP practice or NHS 111 will also usually be directed to call 999. Paramedics will then attend and carry out an electrocardiogram (ECG). They will then triage patients according to the results.
There are broadly two separate pathways when a patient develops chest pain. The first pathway is started if the ECG suggests the patient is suffering a heart attack where the artery is suspected to be completely blocked. This is what is traditionally described and recognised by the public as a ‘heart attack’. This is a time critical problem. The longer the artery remains blocked the more damage the heart sustains and the worse the outcome for the patient. In Lincolnshire, patients will go to the Lincolnshire Heart Centre based at Lincoln County Hospital. Patients are also taken directly to the heart centre if they go into cardiac arrest (ie when the heart has stopped beating) or are transferred as an emergency following successful initial resuscitation if cardiac arrest occurs in another hospital such as Grantham.
Whilst it may sound counter intuitive to have an ambulance driving past the local hospital to a specialist centre, it is the proven safest option for people with acute heart attacks of this nature. It’s not about the distance you travel, but about the ability to provide the most appropriate procedures for a specific condition when a person arrives. This service has been in operation for several years now and has consistently improved the survival rates following heart attacks and cardiac arrests for patients, wherever they live in the county.
Lincolnshire Heart Centre is a specialist centre staffed 24/7 and 365 days a year by a team of highly experienced, highly trained clinical staff and with full support services and intensive care on site. The centre has some of the best survival rates from both heart attacks and out-of-hospital cardiac arrests in the country and it would not be possible to duplicate the team required to deliver this service on multiple hospital sites. This is the reason for centralising such services into high volume heart attack centres across the UK. It would also be detrimental to replicate this service at other hospitals in Lincolnshire, as the more procedures doctors perform the better we become and the better the outcome for the patient. Practice really does make perfect.
Managing patients in this manner is in line with national and international guidelines for how such care should be delivered and is considered best practice.
The second pathway is one for patients with chest pain where the ECG does not suggest complete blockage of an artery.
For these patients whose treatment is less time critical, or people who present with chest pain thought to be secondary to a non-heart related cause, it is reasonable that EMAS may take them to their nearest hospital such as Grantham. If they are assessed as high risk, they will be transferred directly to the heart centre in Lincoln as an emergency at any point in their stay. Patients in Grantham hospital who have non-ST segment elevation myocardial infarction (NSTEMI) – ie where the artery is suspected to be narrowed but not blocked – are ordinarily transferred to the Lincolnshire Heart Centre for their procedure, in order of greatest clinical need.
Those patients who don’t go directly to Lincoln and need to be transferred are likely to have unnecessary delays in their treatment, and significantly more than those who go there directly. These delays are obviously very undesirable for both the patient, their friends and family, and the wider healthcare community and this is why we suggest all patients, both self-referrals and those via 999 are better served going straight to the Lincolnshire Heart Centre.
Councillor, you have said that you took yourself to A&E at Grantham, and that you were later transferred for further more specialist treatment at the Lincolnshire Heart Centre. It is likely that you would have received this treatment sooner rather than having to wait for transfer if you had gone straight to Lincoln. We are very pleased you are doing well after your procedure, and we wish you a full and speedy recovery.
If you or your colleagues would appreciate the opportunity to visit the Lincolnshire Heart Centre, as a guest and not a patient, to allow us to demonstrate the service we provide and to speak to patients who have received their treatment here, we would be only too delighted to facilitate this for them.
We can’t stress enough that a heart attack is a life-threatening condition. We urge people not to ignore symptoms or delay treatment. If they think they or anyone else is having a heart attack, you should phone 999 for an ambulance immediately so that they can be taken to the best place to receive ongoing treatment.
Your sincerely,
Jan Sobieraj (Mr) Dr David O’Brien MD FRCP
Chief Executive Consultant Interventional Cardiologist