Myocardial Ischaemia National Audit Project (MINAP) Context Page

The Myocardial Ischaemia National Audit Project (MINAP) contains information about the care provided to patients who are admitted to hospital with acute coronary syndromes (heart attack). Data are collected and analysed to illustrate the ‘patient journey’ from a call to the emergency services or their self-presentation at an Emergency Department, through diagnosis and treatment at hospital, to the prescription of preventive medications on discharge. Provision of care by staff practising in participating hospitals, and, where relevant, ambulance trusts, is expressed through clinically-important quality improvement/assurance indicators. The audit is delivered by the National Institute of Cardiovascular Outcomes Research (NICOR) hosted by Barts Health NHS Trust.

To view the full audit data set visit NICOR MINAP website

Metrics:

Case ascertainment

• Rationale: This metric shows the proportion of eligible cases that were submitted to the audit.
• Guideline/mapping: There is no national guideline related to case ascertainment however NHS providers are required to participate in national clinical audit as part of their standard contract.
• Graph/relative performance: Compare to the national aggregate (the average). Values can be greater than 100% due to coding discrepancies.
• Quality improvement prompt question: Consider the other metrics in context of case ascertainment; particularly where ascertainment is low. If case ascertainment is low, this should be followed-up with the relevant audit lead to explore poor engagement.

Proportion of patients receiving all appropriate secondary prevention medications

• Rationale: Certain drugs have been shown to reduce the likelihood of subsequent heart attacks in heart attack survivors.
• Guideline/mapping: This metric maps to NICE Clinical Guideline CG 172 recommendation 1.3.1  “Offer all people who have had an acute MI treatment with the following drugs: ACE inhibitor, dual antiplatelet therapy, beta-blocker and statin”  with a standard of 80%.
• Graph/relative performance: Compare to the national aggregate (the average) and national standard.
• Quality improvement prompt question: When performance is lower than the national standard or national average this should prompt questions about how prescription of secondary prevention medications to MI patients is implemented and monitored.

Rate of referral to a cardiac rehabilitation programme following discharge

• Rationale: Cardiac rehabilitation programmes are clinically effective and cost-effective for patients with ACS or previous MI.
• Guideline/mapping: This metric maps to NICE Clinical Guideline CG 172 recommendation 1.1.1 “All patients (regardless of their age) should be given advice about and offered a cardiac rehabilitation programme with an exercise component.” with a standard of 85%..
• Graph/relative performance: Compare to the national aggregate (the average) and national standard.
• Quality improvement prompt question: When performance is lower than the national standard or national average this should prompt questions about how the referral of MI patients for rehabilitation is implemented and monitored.