Heart attack and stroke deaths in Irish hospitals fall sharply over past decade, audit finds

In 2014, heart attacks led to 58 deaths per 1,000 discharges from hospitals. But this improved to 47 deaths per 1,000 by 2023.

The number of patients dying from heart attacks, heart failure and two types of stroke after hospital treatment has fallen significantly in just a decade as care improves, a new clinical audit of 44 hospitals has found.

The National Office of Clinical Audit (NOCA) will on Thursday publish the National Audit of Hospital Mortality national report for 2022 and 2023.

This focuses mainly on trends in heart attacks, heart failure, ischaemic stroke, haemorrhagic stroke, COPD and pneumonia across 44 hospitals.

In assessing deaths from all diagnoses, it also notes changes in recent years.

“Following a gradual decline since 2014, the crude in-hospital mortality rate for all diagnoses increased in 2020 and 2021 corresponding to the major covid-19 pandemic waves,” the audit states.

“[This] subsequently declined by 2023, but remained significantly higher than the pre-covid-19 pandemic rates.” 

In 2014, heart attacks led to 58 deaths per 1,000 discharges from hospitals. But this improved to 47 deaths per 1,000 by 2023.

Heart failure data also reflects improvements in care, with a decline in deaths from 82 per 1,000 discharges in 2014 to 72 per 1,000 by 2023.

Survival rates for patients with ischaemic stroke greatly improved, with a 42% drop in mortality. This rate fell to 63 deaths per 1,000 discharges in 2023 from 109 in 2014.

This is despite hospitals treating more patients for these strokes now.

Deaths from haemorrhagic stroke dropped by 12% in those years, from 335 deaths per 1,000 discharges to 266 per 1,000.

During the pandemic, COPD deaths rose. However this has now stabilised, with 38 deaths per 1,000 discharges in 2023 compared to 37 in 2014.

Deaths from pneumonia also dropped from 140 deaths per 1,000 discharges in 2021 to 100 per 1,000 in 2023.

Cork University Hospital is working with NOCA to review how patients’ data is recorded.

This follows the audit identifying a higher than expected number of deaths linked to COPD from 2022 to 2023 in CUH.

The review showed, however, COPD was the main cause of death in only 33% of cases. Other causes — mainly pneumonia — were identified.

NOCA advised a dictated summary or digital record was needed for all patients to better identify main cause of death. A new method is being tested at CUH.

Ennis Hospital was found to have lower deaths than expected from COPD and heart failure. The hospital said this was down to a dedicated focus on these patients, including specialist nurses.

HSE chief clinical officer Colm Henry said the findings showed “progress being made in Irish healthcare”.

He said “active, time-critical interventions are saving lives” through the reduced deaths from strokes and heart attacks.

Dr Brian Creedon, NOCA clinical director said: “While it is encouraging to see progress for conditions like heart attack and stroke, there is still work to do to address variations, enhance data quality and develop our understanding of potential inequalities.”