The Welsh Ambulance Service will work with researchers from Swansea University Medical School, Kingston University and St George’s, University of London and University of Leeds to identify when ambulance crews should perform a simple ECG test.

The project has received a £197,000 grant from the British Heart Foundation (BHF).

Currently when someone has a suspected heart attack, ambulance crews can perform a pre-hospital ECG. Ambulance staff can then use the results to decide how to treat them, whether they should be taken to a specialist heart centre, and allow for appropriate care to be in place when they arrive at hospital.

Previous research has shown that people receiving the test were more likely to survive, but that around a third of people with a heart attack did not have the test performed, with women and older people being less likely to receive an ECG.

Swansea University says the researchers will study UK wide data on the treatment of heart attacks to determine if use of the pre-hospital ECG is still associated with improved survival rates. When their original work was conducted, clot busting drugs were the principal treatment for a heart attack. Whereas today, primary angioplasty, where a blocked artery is widened using a stent, is the preferred treatment. They will also carry out chart reviews and focus groups with ambulance staff from three ambulance services, including the Welsh Ambulance Trust, to understand when they use the pre-hospital ECG and the decision making process behind it.

By gaining an understanding of what influences the use of ECGs by ambulance crews, the researchers hope to be able to improve guidance on when they could be used more effectively.

Dr Alan Watkins. from Swansea University Medical School, said “Ambulance staff play a crucial role in initiating correct care in a timely manner for heart attack patients. Previous research suggests that patients who have a heart attack and are seen by ambulance staff are more likely to survive if a pre-hospital ECG test is conducted. We hope to build on this research by speaking to ambulance crews to gain insights into the decision making processes of ambulance staff to perform a pre-hospital ECG. Looking at ambulance service and hospital data from across the UK will enable us to gain an understanding as to what would make ambulance staff perform an ECG, this is particularly interesting for those people who have heart attacks but do not present with the typical chest pain and jaw ache symptoms. This knowledge will help us inform future practice and improve patient outcomes.”

Nigel Rees, Welsh Ambulance Service Head of Research and Innovation, said “I have attended patients who have reported symptoms such as dizziness, lethargy, being generally unwell or even a fall and, on rare occasions; this has turned out to be a heart attack. As Paramedics, we are trained to focus on what the patient tells us in order for us to make a good diagnosis, however this study could highlight new areas for us to pay close attention to. If the data shows new areas of concern, we are likely to carry out many more ECGs, diagnosing more heart attacks earlier, which could make a significant difference to the long-term outcome of the patient.”

Adam Fletcher, Head of BHF Cymru, said: “This project aims to answer important questions about how best to treat people suspected of having a heart attack. The results could help inform the way that ambulance crews work. Research like this is only possible thanks to generous donations from the public. Without their continued support we would not be able to fund the work that can help us improve the treatment and care of heart patients.”

A pre-hospital ECG is a test that paramedics can perform on someone with acute chest pain. The device measures electrical activity in the heart through a series of wires attached to the person’s chest. The test, which takes about ten minutes to perform, can diagnose a heart attack.

In the UK there are nearly two hundred thousand hospital visits each year due to heart attacks, the equivalent of one every three minutes. In the sixties more than seven out of ten heart attacks in the UK were fatal, but advances in treatment mean at least seven out of ten people survive today.

A heart attack happens when there is a sudden loss of blood flow to a part of the heart muscle. Heart attack symptoms vary from one person to another. The most common signs of a heart attack are pain or discomfort in the chest. But other symptoms can include pain in the arm, neck, and jaw, or feelings of sickness, light headedness or shortness of breath.