11 May 2008

Darzi's heart attack management

According to Lord Darzi this is how the NHS should change its practice to manage heart attacks. Or so it seems from his latest report.

Dr Grumble is utterly gob smacked. If this is Lord Darzi's idea of an improvement then there's trouble ahead. We can do better. Much better.


Anonymous said...

How can he be that out of touch with what the gold standard of care now is?

peacemaker said...

Lord Darzi says that 'what was high quality in 1948 or 1998 is often not regarded that way in 2008'. But he fails to realise that what he himself writes in May 2008 is out of date even before the ink is dry. The NHS is changing very quickly and is already ahead of him when it comes to the optimum management of heart attacks. So why does he keep hectoring us to do better? Is he really as out of touch as he seems?

Anonymous said...

As a Paramedic I recognise that PCI is the better option, but the nearest centre offering PCI to where I work is about 3/4 hour away and at night or the weekend it is about an hour away. So thrombolysis is the next best thing, and we give it independently - we used to send an ECG by telemetry to the doctor in A&E, but they couldn't / wouldn't engage with the technology.

Another consideration, is that with the very best will and a co-operative patient it can often take 15 minutes to get a patient out of the house (they still need to put out the cat, lock the doors, have a wee and get meat out of the freezer - EVEN when they are having an MI!), so an early start to treatment can only be a good thing with the length of travel added on.

In London, I understand Paramedics don't thrombolise routinely as they have a wide selection of 24 hour access angio suites to choose from. It's tough in the country sometimes.

Dr Grumble said...

So Lord Darzi has his finger on the pulse after all. Thanks Paramedic. Actually I don't live in London and we have primary angioplasty round here - though not that close. Is the East of England very remote? I suppose it must be.

Dr Grumble said...

On reflection, Paramedic, I still don't think Lord Darzi is aiming high enough. It's not my field but I still think we could be doing much better.

Here is a paper on the topic.

It concludes:

Thrombolysis has been the mainstay reperfusion strategy for ST elevation MI for a number of years. Primary PCI has been shown to have superior acute and long-term clinical outcomes. Incorporating a primary PCI strategy within an NHS setting seems likely to offer superior clinical outcomes, but will require significant service reorganisation.

Lord Darzi seems to be aiming for yesterday's treatment. He can do better.

Dr Grumble said...

It turns out that one of Dr Grumble's friends, Huon (who is named after a river) has written a report on this topic for Lord Darzi. He starts saying:

Primary angioplasty services are one example where clinical evidence on outcomes is pointing to the need to deliver services in a different way.

He concludes:

The development of primary angioplasty services is feasible in a variety of settings.

So why hasn't it happened? It turns out, surprise, surprise, that many sites 'reported difficulty in gaining the agreement of purchasers'.

But who gets the blame for our failure to progress? With this government it's the NHS professionals. Always.

Anonymous said...

The fault, Doc G, lies with the Department of Health. As long ago as August 2003 the Prime Minister’s Delivery Unit concluded:

The Department of Health should develop a clear policy for expanding primary angioplasty.

This has nothing to do with doctors or other healthcare professionals dragging their feet. But they do seem to have to take all the blame.

MR said...

Quite right, Dr G.


Health Direct said...

Lord Darzi is clearly flat lining.

As far back as March 08, 2005 Health Direct posted: 25,000
die from preventable VTE

Each year over 25,000 people in England die from venous thromboembolism (VTE)
contracted in hospital. This is more than the combined total of deaths from breast
cancer, AIDS and traffic accidents, and more than twenty-five times the number
who die from MRSA. The figures are alarmingly high.

kaney said...

Venous leg ulcers are caused by blood pressure build up in the leg's veins. Faulty valves are the cause of this condition. Instead of blood flowing upward toward the heart as it should, it flows backward. This causes damage to the tiny vessels inside the skin and causes dry and itchy skin along with inflammation.