Managing a heart attack is very different today to ten or twenty years ago. There are now interventions that can limit the damage to the heart such as thrombolysis (clot busting drugs) and Primary PCI (a type of heart procedure to remove the blockage in the arteries).
Primary PCI is done on STEMI heart attacks (that’s about 20% of heart attacks) and is done in a specialist centre by an experienced cardiologist. To be a specialist centre doing PPCI you need a critical mass of population with a large volume of cases (approx. 200 cases per year) and enough experienced cardiologists to cover a 24/7 rota (6 or more). Up to now 3 centres in Dublin have been covering Dublin and surrounding counties.
The provision of Primary percutaneous intervention (PPCI) from three 24/7 centres in Dublin had proved unsustainable. In November 2014, the Acute Hospitals Division of the HSE requested the National Clinical Programme for Acute Coronary Syndrome (ACS Programme) to review the current configuration of PPCI services in Dublin, having regard to the requirement to deliver safe, sustainable services on the designated sites. The review looked at the number of centres that should be delivering PPCI in Dublin, where these centres should be located and the feasibility of maintaining 9 to 5 PPCI services on any cardiology intervention site.
The review was informed by advice from the principals involved in PPCI centres in the UK and other European countries and by models of care from the US and Australia. Experience at national and international level highlights the importance of having sustainable rotas of clinical staff to support the 24/7 requirements of this service. Following a consultation exercise with all relevant hospitals and the National Ambulance Service, the final report recommended that there should be two 24/7 PPCI centres for Dublin to be located in the Mater and St. James’s Hospitals, which would accept all ambulance transfers of patients with ST elevation Myocardial Infarction (STEMI).
The rationale for two 24/7 centres for the delivery of PPCI in the greater Dublin area reflects the international trend towards the consolidation of such specialised services on smaller numbers of sites to allow for the concentration of volume and a larger critical mass of trained operators, working within a 24/7 team that is less dependent on individual personnel and is, therefore, more robust. This is about starting treatment the moment the paramedic arrives and getting patients to the right hospital in an emergency - rather than just the nearest one only to be transferred later after a delay.
The Deputy may wish to note that, in relation to the treatment of STEMI patients from Wicklow and South Dublin, the requirement for travel time from First Medical Contact to PPCI centre to be within 90 minutes was considered as part of the review, and the report notes that 90 minute travel time for St Vincent's Hospital and St James’s Hospital are similar.
The report also recommended that there should be a clear definition of the role of the three other cardiology intervention centres in Dublin (Beaumont Hospital, Tallaght Hospital and St Vincent’s University Hospital (SVUH)) in the management of Non ST Elevation Myocardial Infarction (NSTEMI). NSTEMI forms an increasing proportion of interventional work which will continue and develop in those cardiology intervention centres which will not be designated 24/7 PPCI centres including St Vincent’s Hospital.
The Deputy may also wish to note that, in advance of the implementation of the change to the delivery of the PPCI service in the Dublin area, extensive consultations took place with stakeholders including the Chairs and CEOs of the two Hospital Groups concerned (Ireland East Hospital Group and Dublin Midlands Hospital Group); the CEOs of the relevant hospitals and the National Ambulance Service and I am pleased to note that all are fully supportive of the new arrangements, which were implemented on April 17.
