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A patient's chance of dying from a heart attack or stroke can vary depending on what hospital they attend

The report notes that the mortality rate for heart attack and stroke has continued to decrease year-on-year for the past 10 years.

The report notes that the mortality rate for heart attack and stroke continues to decrease year-on-year for the past 10 years.
The report notes that the mortality rate for heart attack and stroke continues to decrease year-on-year for the past 10 years.
Image: Shutterstock/nhungboon

THE CHANCE OF dying of a heart attack or a stroke can vary significantly depending on the hospital you attend, a new Department of Health report has shown. 

The National Healthcare Quality Report documents a broad range of health service issues, including vaccination rates, the use of medication on patients and caesarean sections, to name but a few.

The report notes that the mortality rate for heart attack and stroke continues to decrease year-on-year for the past 10 years.

Reviewing the three-year period from 2016-2018, it was found that in most hospitals the  standardised mortality rates were within or lower than the expected range.

The report ranks a number of hospitals across Ireland, with some presenting 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 University Hospital Kerry (7.21) and Bantry General (8.93). 

St Vincent’s Hospital, Dublin has a rate of 6.88, University Hospital Waterford has a rate at 6.85 and St James’s Hospital stands at 6.07.

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

Health warning on stats

However, the report gives a health warning on the statistics, stating that there are several reasons for the variations in hospitals. 

“The fact that a rate is statistically significantly different does not necessarily mean that there is a difference in the quality of care provided, either good or bad. Rather, it indicates that the rate is different from what would have been expected and the reasons for this should be examined further by those tasked with providing that health service,” states the report. 

It adds that there can be many reasons why the mortality rates for a hospital would be higher or lower than the national average, such as it could be dependent on the different in the types of patients that attend different hospitals, for example some hospitals may have a higher or lower proportion of patients with other medical conditions attending than others and this may influence outcomes. 

There could also be inconsistencies in the quality of the data gathered in different hospitals, as well as differences in access to medical care prior to arrival at the hospital. 

“It cannot be concluded that a high mortality rate is indicative of poorer quality care,” adds the report. 

Speaking on RTÉ’s Morning Ireland, Professor of Health Systems at DCU’s School of Nursing Anthony Staines said:

“If you see a hospital where the death rate from heart attacks is consistently high, you need to look at it and ask what’s going on.

“It could be as simple as a very elderly population, it could be down to the facilities and resources within the hospital, it could be down to travelling time to the hospital, it could be how people are presenting.

“But it’s saying there’s a question you need to ask.”

HPV vaccine

The Department of Health report also states there are “substantial variations” nationwide in the uptake of the HPV vaccine, and notes that in other vaccine groups national targets are not being met. 

The report also looks at cancer survivor rates, and finds that survival rate from breast cancer is lowest in the west of Ireland at 80% and highest the south at 86.6%. 

Between 2011 to 2015, the national average survival rate for breast cancer was 85%. 

The report finds that in Dublin and mid-Leinster the survivor rate is 86.3% and 85.9% in  the north-east of the country. 

The survival rate from cervical cancer was 66.2% nationally from 2010 to 2015, with the report noting there was no statistically significant difference between the national rate and any of the four regions.

For the period 2010- 2014, the survival rate for cervical cancer in Ireland was 63.6%, below the OECD average of 65.7%.

These statistics relate to the time before the CervicalCheck scandal broke in May 2018. 

How many are getting screened and tested?

In terms of screening, over the past 10 years the uptake of breast cancer screening among eligible women invited by BreastCheck averaged 76.4%. This is higher than the OECD average of 60.8%. 

All counties are above the 70% national target. Below sets out the average screening rate per county. 

HPV

The coverage of screening by CervicalCheck in the 2017, the latest time period for which data is provisionally available, shows the screening rate at 78%.

Women aged 25 to 29 are the category most likely to present for screening, and at a county level, screening uptake rates 2012-2017 ranged from 70% in Laois to 91% in Carlow.

Below shows the screening rates for cervical cancer by age and by county. 

HPV

Eight counties achieved the 80% target coverage for the time period.

The report notes that the reasons for the variation in uptake rates in different locations “require further investigation”.

Although, Ireland has not yet reached its national target of 80% uptake, Ireland’s rate of uptake for cervical screening is significantly higher than the OECD average. 

The National Healthcare report also looks at issues such as the use of medication on patients and caesarean sections, adding that there is “room for improvement” in these areas.

Ireland’s caesarean section rates continues to rise year on year, states the report, adding that it is above the OECD average.

Ireland’s national chronic use of benzodiazepine medications in people aged 65 years and older in the community is high compared with international averages, with the report stating that more women than men are taking them. 

The report also found that many patients said they did not feel they received the emotional support they needed while being cared for in our hospitals

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