SMOKERS WHO EXPERIENCE a major heart attack do so 11 years earlier than non-smokers, and for women the gap widens to 13 years.

Current smokers who present with major heart attacks in Ireland have a median age of 57, compared to 68 for non-smokers.

Among women, current smokers presenting with a major heart attack have a median age of 61, compared to a median age of 74 among non-smokers.

That’s according to the 2024 Irish Heart Attack Audit National Report, which is compiled by the National Office of Clinical Audit (NOCA).

The 2024 report found that smoking remains a “major risk factor” when it comes to heart attacks.

In 2024, more than a third (36%) of patients presenting with a heart attack were current smokers, which is double the national average.

Those under 40 years of age who have a major heart attack are also three times more likely to be smokers.

The NOCA said these findings “reinforce the need for continued public health initiatives to reduce smoking”.

Early symptoms

The report examined data on some 1,615 patients who presented with major heart attacks in 2024 and aims to highlight processes that are working well, while identifying areas that could be strengthened.

While early symptom recognition is among the key determinants of care, only 45% of patients called for an ambulance within an hour of symptom onset.

As in previous years, more men sought help within an hour of symptom onset than women.

Symptoms of a heart attack include shortness of breath, sweatiness, unusual stomach pain and confusion.

It can also include pain, discomfort, pressure, tightness or heaviness in a number of areas such as the jaw, neck, shoulders, back, chest and arms.

Primary PCI

Meanwhile, primary PCI is the term for the preferred emergency treatment of major heart attacks, also known as ST-elevation myocardial infarction (STEMI).

However, only 77% of patients who had a major heart attack in 2024 received primary PCI, down from 86% in 2017.

The NOAC said this decline reflects two key issues: delayed patient presentation to hospital and initial presentation to non-PCI-capable hospitals.

Only 55% of patients arrived directly by ambulance to a PCI centre in 2024, with a further 10% self-presenting to a PCI centre.

The report also found that only 55% of patients arriving directly by ambulance to a PCI centre achieve the 30-minute “door-to-balloon” target of how long it takes doctors to open a patient’s blocked arteries and restore blood flow.

And of patients who first presented to a non-PCI capable hospital, only 3% achieved the 30-minute “door-in door-out” target for transfer to a PCI centre.

Meanwhile, only 61% of patients received primary PCI within the recommended two hours after a heart attack is diagnosed, down from 68% in 2017.

‘Essential’ recommendations 

The report’s authors have called for an improvement to the rate of primary PCI for people who have a major heart attack and a reduction in “door-to-balloon” times.

They added that the findings underscore the need for a targeted public awareness campaign on recognising heart attack symptoms and on the importance of seeking immediate care at an appropriate hospital.

The NOAC remarked that its recommendations are “essential steps towards ensuring that every patient in Ireland receives timely, effective and equitable care”.

Dr Colm Henry, Chief Clinical Officer of the HSE, welcomed the report and stated that there are “improvements to be made”.

He said the HSE’s National Heart Programme has developed an action plan to address the report’s findings.

This plan includes a proposal to set up new regional primary PCI groups in each of the six Health Regions.

This is in addition to the designation of University Hospital Waterford as Ireland’s seventh 24/7 primary PCI centre, which was announced by Health Minister Carroll MacNeill in April 2025.