1. Primary Care Acute Chest Pain Awareness

2. Background BHF Funded Mid & South West Wales Project –Report from MINAP (Myocardial Ischaemia National Audit Project) ―2005-6 Data ―Higher proportion of people in Wales called/visited GP rather than calling 999 with chest pain

3. Background MINAP Analysis – Network Level –Admission Diagnosis: Definite MI 9% 20% 3%

4. Background Cardiac Networks Co-ordinating Group: Call-to-Needle Subgroup Recommendations –Need to raise awareness of symptoms and a clear message of what to do if symptoms occur 1 –Need ongoing innovative campaigns to raise awareness 1 1 Recommendations for improving call-to-needle times in Wales (2007); recommendation 1.5

5. Background Annual Operating Framework Target 12 (2008-9) –All patients with MI suitable for thrombolysis will have a CTN time < 60 minutes ‘The Golden Hour’ and ‘One minute delay = 11 days loss of life’ 1 1 Boersma E, Maas ACP et al early thrombolytic treatment in AMI: reappraisal of the golden hour; Lancet 348: 771-775

6. Background Standard 3 - National Service Framework for Coronary heart disease (June 2009) –Point 3.10 ‘If a GP is called for symptoms suggestive of acute coronary syndromes, the GP should call 999 for an ambulance prior to attending to give assistance’

7. Aims To raise awareness within Primary Care of importance of immediate admission of suspected MI To reduce pain-to-call time/pain-to- reperfusion time

8. Project Outline Provide poster pathway and education to Primary care –For clinical staff to support management of acute MI Provide workshops in primary care to implement project and raise awareness

13. Timeframe Project implementation across primary care in Mid & West Wales –Commenced November 2008 –To be evaluated March 2011 Project implementation within HM Prison Service in Wales –Commenced July 2010 –To be evaluated March 2011

14. Measurement of Expected Benefits MINAP Data comparison Project Evaluation Pre/Post project staff survey

15. Interim Analysis 1 Increased confidence by both administrative and clinical staff in dealing with acute chest pain calls/presentation

16. Source: Post-Implementation Awareness and Confidence Survey

20. Interim analysis 2 Fewer patients told by staff to make their own way to hospital

21. Source: MINAP

22. Interim analysis Stated change in practice towards advising 999 call rather than arranging same day appointment/home visit Verified change in practice demonstrated through MINAP data

23. Source: Post-Implementation Awareness and Confidence Survey

25. Source: MINAP

26. Conclusions Improved patient care by appropriately accelerating admission to paramedic/secondary care Structured, evidence-based resources, generic and universally suitable for use in all primary care sites Reduce call-to-needle times and accelerate care of all ACS patients

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