Rapid access cardiology saves lives

Doctors at Barts and The London NHS Trust are at the forefront of efforts to find new treatments for heart disease. They were among the first in the UK to offer emergency angioplasties routinely to heart attack patients in 2003 and have continued to pioneer in the field of cardiac care with the introduction of new technology and services aimed at delivering early diagnosis and intervention. A new cardiology service for patients most at risk of having a heart attack, was launched last year at Barts and The London Heart Attack Centre (based at The London Chest Hospital in Bethnal Green). Doctors now intervene with advanced cardiology procedures at the “early warning” stage instead of waiting to treat patients who have suffered a fullblown heart attack. The aim has been to give east London, which has the most cardiovascular disease in the Capital, a comprehensive roundthe- clock specialist cover for the whole spectrum of acute heart attack illnesses. The 24/7 emergency service is tasked with saving around 1,800 at-risk patients a year from having heart attacks in the future.

The London Heart Attack Centre extension (HACX) caters specifically for those who have a partial blockage of a heart artery, which, if left untreated, could lead to a complete blockage and a fullblown heart attack. Patients with partial blockages can spend weeks or even months before a full diagnosis happens and treatment commences. The service streamlines the patient pathway by transferring the patient directly from their local A&E to the HACX, saving valuable time and avoiding the need for multiple appointments for tests and treatment. The rapid access service ensures that all patients at risk of a major heart attack are diagnosed and treated within 24 hours. A successful pilot trial at The Royal London Hospital in Whitechapel and at Newham General Hospital targeted patients at high-risk of a threatened heart attack between November 2007 and February 2008. It concluded that patients could significantly reduce their length of stay in hospital and improve their chances of survival if the service was provided. International expert and senior cardiologist at Barts and The London Heart and Chest Centre, Professor Martin Rothman, said: “We wanted to test the feasibility of rapid access cardiology and, having looked in detail at all the stages patients currently go through, we decided it would save a lot of lives, a lot of money and a lot of time to launch this service. “By doing this, we can prevent patients from having heart attacks in the future. Our pilot demonstrated quite clearly we can reduce the length of stay for patients in hospital and that is a significant achievement.

This is also beneficial to the NHS, as it reduces costs involved in the management of patients suffering from chest pain. The service acts as an early warning system for heart attack which is probably the best contingency measure one could ask for. Patients still go to their local hospital A&E department with chest pains, where they have an ECG test and specific blood tests looking for early signs of heart muscle injury. “What is different is that those at high risk are transported immediately to Barts and The London Heart and Chest Centre for an angiography to assess their heart. If we find arteries that are severely narrowed or partially blocked with a blood clot, then they will usually have an angioplasty to open up and secure the artery. We are able to discharge selected patients home within 48 hours of presentation. “This service complements the pioneering Barts and The London Heart Attack Centre service, which already treats full-blown heart attacks immediately.’’ In its first year, Barts and The London Heart Attack Centre halved the number of deaths among heart attack patients.