Increase happened “from one year to next”, between 2021-2022
Around 80 health professionals have signed an Open Letter querying the causes behind the 73% increase in heart attack patients requiring transportation to hospital by INEM in 2022.
The letter, entitled “Increase in myocardial infarctions in the Portuguese population” was sent to “several entities”, in February.
Cardiologist Teresa Gomes Mota tells Lusa: “”From one year to the next, having an increase of 73% of patients with heart attack transported is something very worrying and should deserve, immediately, several questions and several explanations”, whether from INEM itself, or any of the entities to which the Open Letter was sent. (These include the prime minister, minister of health, executive director of the SNS State health service, president of INEM, president of the Portuguese Society of Cardiology, president of the Portuguese Association of Cardiovascular Intervention, president of the Paediatric Intensive Care Society, parliamentary groups and parliamentary health committee).
But up until today, well into the second half of April, no replies have been received.
As Lusa explains, the Open Letter is based on data released by INEM in February this year which showed that the institute “referred 1,556 cases of acute myocardial infarction (commonly called a heart attack) to the “most appropriate hospitals, through the Coronary Green Line“
INEM recognised that its data reflected “a higher number of records (of patient transportation) compared with previous years, with an increase of 73% (658 more patients) compared to 2021”, Lusa’s report continues.
Teresa Gomes Mota explains this could conceivably be down to INEM having “greatly increased its efficiency”. It could conceivably not be a problem of an increase in heart attacks, but rather an increase in the transport of people suffering from them, “but this must be demonstrated”.
The purpose of the Open Letter is not to raise alarm, she stresses, “but to understand what is happening”.
As the medical health professional continued: “If Portugal had a stable number over several years of patients transported with myocardial infarction, but that in 2021 increased and in 2022 had an exponential increase, something is happening and it is very important to clarify” what it is.
In addition to the increase in people transported, the Open Letter warns of the “significant worsening of time between the onset of symptoms and the activation of INEM“, which reached “up to six hours in 63% of patients, against a history of less than two hours for 73% of victims in 2021, 72% in 2020, 74% in 2019 and 71% in 2018″.
Indeed, this issue with ambulances, and how they are not reaching people in time was highlighted only yesterday by the Portuguese union of pre-hospital emergency technicians.
Teresa Gomes Mota stresses that the most effective treatment for acute myocardial infarction is coronary angioplasty, which should be performed as early as possible to increase the probability of effectiveness.
In view of this “it is important to know why” the waiting times for ambulance response “have increased”.
Although stressing that the determination of causes depends on the study of available data, Teresa Gomes Mota admits that a probable cause could be the lack of assistance in health units during the first years of the pandemic, which “has many components”.
Among these, she listed the “fear of people to resort to the hospital and health centres, so as not to be infected by Covid-19”, and the “interruptions of medication” for hypertension and cholesterol, due to lack of access to doctors in the initial phase of the pandemic.
But given this latest INEM data, she and the other signatories of the Open Letter “urgently request an investigation and comparative analysis”, taking in Ministry of Health figures regarding emergency calls, transport and hospital admission, sudden death and in-hospital and out-of-hospital death from acute myocardial infarction between 2018 and 2022.
The letter also calls for the collaboration of the Portuguese Society of Cardiology (SPC) and the Portuguese Association of Cardiovascular Intervention (APIC) and other entities and scientific societies in order to “perform a timely technical analysis of data on transport, hospitalisation and cardiovascular intervention in patients suffering from myocardial infarction and sudden death” in the same period.
The signatories include 62 doctors from various specialties, who point out that 2022 saw the highest number of emergency calls ever recorded by INEM – more than 1.5 million – as well as excess mortality, for which acute coronary accidents may have made a “particular contribution, a situation that must be characterised, understood and overcome”.
The letter ends with the observation that “only with everyone’s commitment and collaboration will it be possible to identify the causes of this excess mortality and adopt intervention strategies to prevent loss of life”.