This will not be good reading for those who are campaigning to keep local DGHs open, Ischaemic Heart Disease is a big killer, and is unexpected for many people. Despite the evidence from Denmark, and other sources, patients may prefer to die younger and have a local option for care. The problem is the limited resources, and utilitarianism. To fund the periphery adequately means fewer resources for the centre. When all the stakeholders are taken into account the centralisation of care is the only rational option. Although “Small is beautiful” for many low profile services, it is the giant mutual which brings the greatest dividends in health, technology, and survival. Ghandi’s Swardeshi is all very well…, but when I am given the information, and the choice, I will surely travel.
Heart patients who are taken past a local hospital to a specialist unit are up to 45 per cent more likely to survive, a study has concluded. Even patients who had to travel long distances were better off in a hospital with high-tech treatments, according to research that boosts the case for centralising NHS care.
Doctors increasingly believe that concentrating complex care in fewer, specialist centres is better for patients but have struggled to make it happen amid protests about downgrading local hospitals. Danish researchers looked at data on 41,000 patients who suffered cardiac arrests outside hospitals.
Only 9 per cent were still alive 30 days later but the 29 per cent who went direct to a specialist heart centre were 11 per cent more likely to be among them. This rose to 45 per cent for those who had interventions to detect artery blockages and keep blood flowing. Distance to the specialist centre did not appear to affect chances of survival, researchers report in the European Heart Journal.
Centralisation, with fewer, high-volume, invasive heart centres, is essential
Tinne Tranberg, of Aarhus University Hospital, who led the study, said: “Among cardiac arrest patients admitted to hospital, those admitted directly to an invasive heart centre have a higher chance of surviving, regardless of the distance.” She added: “Centralisation, with fewer, high-volume, invasive heart centres, is essential for advanced care.”
Dr Tranberg said that Denmark’s experience would probably apply to the NHS, adding: “These results support a strategy that prioritises the establishment of an efficient pre-hospital organisation, over the establishment of multiple geographically distributed heart centres, and suggest that patients should be admitted directly to a few invasive heart centres for optimal care.”
Patients who received CPR from a bystander had a 10 per cent better chance of survival, while those whose cardiac arrest was witnessed by other people were 12 per cent more likely to survive. Survival was also higher among patients who collapsed in crowded areas, underlining the importance of immediate medical attention.
Instant specialist attention has been credited with saving the life of Fabrice Muamba, the footballer who suffered a cardiac arrest while playing for Bolton Wanderers against Tottenham Hotspur at White Hart Lane in 2012.
After expert help on the pitch, an ambulance took him to the London Chest Hospital six miles away, rather than to the North Middlesex University Hospital less than a mile away.
About 30,000 people suffer cardiac arrests outside hospital in Britain each year. Mike Knapton, associate medical director of the British Heart Foundation, said: “If you have an out of hospital cardiac arrest, your chances of survival improve if you are taken to a specialist heart centre. This isn’t the first time that research has pointed towards paramedics bypassing local hospitals and heading to one of the UK’s specialist heart centres. Paramedics make these specialised hospitals the first point of call, providing they are within a reasonable distance.”
PMI or private cover? Should GPs ask patients if they have private health insurance? Putting the patient in front of you at the centre of your concern – includes asking about attitudes to non state options..