Monday 16 September 2019

Heart attack death risk ‘much higher’ in some hospitals

Report calls for more investigation after it reveals significant differences in survival rates for patients

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Eilish O'Regan

Eilish O'Regan

A patient's chance of dying after a heart attack or stroke can vary significantly depending on their hospital, a report has revealed.

A number of hospitals across Ireland are ranked with much higher mortality rates for heart attack victims than the national average of 5.29 deaths per 100 patients.

Those with the highest death rates within 30 days of admission include Bantry General (8.93), Portiuncula Hospital (8.53), and University Hospital Kerry (7.21).

Among major hospitals with above average rates were St Vincent's Hospital, Dublin, with a rate of 6.88, University Hospital Waterford at 6.85 and St James's Hospital with 6.07.

The statistics were compiled between 2016 and 2018.

The lowest rates were reported in Our Lady's Hospital, Navan, and St Luke's Hospital, Kilkenny.

The figures in the annual report of the National Healthcare Quality Reporting System are the nearest the hospital system gets to a league table.

But the report cautions there may be several reasons for the differences.

These include the access to care the patient had before admission to hospital, their overall health, transfer patterns between hospitals and inconsistences in the data.

But the report concludes that the higher than average mortality rates in certain hospitals require further investigation.

"It cannot be concluded that a high mortality rate is indicative of poorer quality care," the report says.

"Rather it provides an indication that a further evaluation should be carried out to determine the reasons for the identified variation."

The report also shows variations in death rates from ischaemic strokes, the most common form.

The highest mortality within 30 days of admission was in St Luke's Hospital in Kilkenny, where the rate was 13.08 per 100 cases, almost twice the national average of 7.82.

The lowest were St James's Hospital, Dublin, Mercy Hospital, Cork, and Waterford.

Death rates for haemorrhagic stroke were highest in Naas General Hospital, St Luke's Hospital Kilkenny and Galway University Hospital.

Overall, mortality rates for stroke and heart attack victims have decreased year on year for the past 10 years.

The report also showed variations in waiting times for a surgery for a hip fracture in different hospitals. St Vincent's Hospital performed best for carrying out surgery within two days of admission, at 97.3pc. Cork University Hospital was the worst, at 76.1pc of surgeries within two days.

Hospital comparisons for caesarean section show it is highest in the Rotunda Hospital at 38.4pc of births and in Mullingar Hospital at 38.3pc.

Hospital comparisons for caesarean section rates show they are highest in Cavan Hospital at 38.4pc and in St Luke’s Hospital, Kilkenny  at 38.3pc. It is 34.2pc in the Rotunda Hospital. The national average is 32.2pc.

Room for improvement was highlighted in the rising level of antibiotic use in hospital as well as below-target uptake of flu vaccine among over-65s.

On the plus side, admissions to hospital for diabetes and heart failure have fallen, while the survival rates for breast, cervical and bowel cancer are continuing to improve.

Rates of MRSA have dropped by 66pc in 10 years.

Health Minister Simon Harris said it was good to see death rates from heart disease and stroke in Ireland are below the OECD average but he pointed to the failure to reach targets for the uptake of certain vaccines.

The findings of the report should be used as a "tool" to drive better performance, he added.

"While there is undoubtedly more to do, it is encouraging to see that the number of people hospitalised for asthma and heart failure are below international averages. However, the report also shows a number of areas where we could improve," he said. "The amount of antibiotics used in our hospitals remains high."

Secretary general of the Department of Health Jim Breslin also pointed out areas that needed to improve. "It is disappointing the national influenza vaccination rate for those over 65 and our healthcare workers is not reaching our target rate," he said.

"We can also see the number of caesarean sections continues to increase and is deviating even further than the OECD average.

"Our use of benzodiazepine medications in those over 65 years of age, particularly in women, is higher than known international averages."

Irish Independent

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