As the report states, accident and emergency (A and E) units are not always the best places to treat heart attack and stroke victims.
For treatment of heart attack, the key facility required is a catheterisation laboratory. The Department and the new opportunities fund have provided funding of £125 million to build 90 new or replacement catheterisation laboratories in England, increasing the capacity previously available by more than 50 per cent. The emerging findings from our national study of primary angioplasty show that the best times are achieved by ambulance paramedic triage and taking patients direct to the catheterisation laboratory without going via the A and E department.
It is more appropriate for stroke victims to be taken directly to a stroke unit rather than to an A and E unit. Early analysis of best evidence provides an estimate that to provide immediate scanning for all stroke patients and increase uptake of thrombolysis to 4 per cent., currently being achieved by the centre with the highest thrombolysis rate in England, will cost £6.7 million to £8.7 million. To increase uptake to 10 per cent. (currently being achieved by leading centres around the world) the estimated cost is £10.9 million to £12.9 million. However, analysis also demonstrates that this investment will result in considerable long-term savings, and allow a significant number of stroke patients not only to survive, but to live fully independent lives.
The national service framework for coronary heart disease set a target that thrombolysis, treatment with clot-busting drugs, should be given to heart attack patients within 60 minutes of calling for professional help. Good progress has been made with meeting this target but there has been less progress in reducing the time from pain to call. Public awareness of symptoms is a key issue here. The Department is supporting the British Heart Foundation's recently launched campaign to raise awareness of heart attack symptoms. Primary angioplasty is most effective when delivered within three hours of onset of symptoms but will provide some benefit up to 12 hours after they have developed.
Thrombolysis for stroke patients must be delivered within three hours of onset of stroke. The licence for the thrombolytic drug for stroke is only for delivery within three hours. It must be noted that a stroke may not involve pain so increasing awareness of the symptoms of stroke is an important part of delivering thrombolysis. The Department is currently supporting the Stroke Association FAST campaign which provides a clear and simple test to identify a stroke.