Fewer patients dying from heart attacks in Irish hospitals
The proportion of people dying in Irish hospitals after being admitted having suffering a heart attack has almost halved in the last 10 years.
The finding is published the National Office of Clinical Audit (NOCA) in its third report from the National Audit of Hospital Mortality (NAHM).
The study presents information across six specific medical conditions: Acute myocardial infarction/heart attack, heart failure, ischaemic stroke, haemorrhagic stroke, chronic obstructive pulmonary disease, and pneumonia.
NAHM uses data from 44 publicly funded hospitals in Ireland.
All hospitals were within the expected range for the six listed medical conditions.
The report reveals there has been a “significant reduction” over 10 years (47%), in the number of people dying in hospital after coming in after suffering a heart attack — falling from 9.3 per 100 admissions in 2008 to 4.9 per 100 admissions in 2017.
There has also been a significant reduction over the past decade (26%) in heart failure in-hospital deaths per 100 admissions, from 9.5 in 2008 to 7.0 in 2017.
The number of people dying in hospital after suffering an ischaemic stroke has fallen 28% in the same period — from 13.4 per 100 admissions in 2008 to 9.7 per 100 admissions in 2017.
However, in-hospital deaths in relation to other medical conditions have not fared as well. For example, there has been no significant reduction in the number of in-hospital deaths for patients with haemorrhagic stroke.
Those figures have fallen by 10% from 30 per 100 admissions in 2008 to 27.1 per 100 admissions in 2017. Deaths from COPD in hospital have fallen by 18% in the decade, from 4.2 per 100 admissions in 2008 to 3.5 per 100 admissions in 2017.
There has been a small but significant reduction (17%), in the rate of pneumonia in-hospital deaths per 100 admissions, from 14.1 in 2008 to 11.7 in 2017.
Shared learnings from hospitals are a central feature of the report. During 2017, St James’s Hospital in Dublin was outside of expected ranges for AMI/heart attack. The hospital’s clinical and quality team carried out a detailed review of source data and coding, which resulted in learnings on the importance of data quality and the local collaboration between clinicians and coders.
St James’s Hospital put a plan of action in place and the mortality rate for heart attack at year-end was within expected ranges. There were no patient safety concerns.
Brian Creedon, NAHM Clinical Lead, said the highlighting of data issues show that hospitals are using NAMH data to improve the health system.
“The inclusion of a clinically-led hospital review from St James’s Hospital, showing where there are data issues and how they have been delved into, is very important,” said Dr Creedon. “It shows that hospitals are now using NAHM data to make an impact on the health system.”
The NOCA pointed out that the report cannot be used to compare hospitals, pointing out that no two hospitals are expected to be the same, as hospitals have very different case mixes or patient profiles.
As a result, standardised mortality ratios can only be used to examine mortality patterns within a hospital and not to compare hospitals with each other.
