NHS commissioners have been asked to develop a national network of cardiology services capable of delivering primary angioplasty as the main treatment for heart attacks.

In a move that will have implications for service reconfigurations already under way across England, the Department of Health has called for a national roll-out of the treatment over the next three years.

The final report of the national infarct angioplasty project, set up by the DH, concluded that it is both feasible and cost-effective to offer angioplasty as an emergency treatment for 97 per cent of the population of England.

It would replace thrombolysis, the injection of life-saving clot-busting drugs, as the first line of treatment.

Primary angioplasty involves inserting, then inflating, a small balloon in the blocked coronary artery, leaving in place a rigid support to restore blood flow.

Specialist services

If delivered within two hours, it has better outcomes and could save 240 lives a year. But it requires direct admission to a cardiac catheter laboratory so would need not only a network of labs but also the involvement of ambulance staff to take patients directly to them.

The nationwide service recommended by the report would require health communities to revisit their reconfiguration plans to ensure centres are staffed with relevant expertise and open 24 hours a day, seven days a week.

National director for heart disease and stroke Roger Boyle said: "Planning is already under way in pretty much all areas. It is not really challenging because in most places it will bolt onto existing infrastructure."

Rural areas such as Cumbria and parts of Lincolnshire faced some challenges, he said, and the service would probably not be deliverable in island communities such as the Isle of Wight or the Scilly Isles.

Ambulance trusts were already on board in some areas, he added.

Direct admission

"The London Ambulance Service trust has led the way and last year only six patients received thrombolysis," he said. The rest were taken directly to specialist cardiac centres where they received primary angioplasty. He added: "We are now confident that the model works in a variety of settings and where there is a will there's a way. The majority of the report's recommendations will be in place in 18 months."

London Ambulance Service trust clinical practice manager Mark Whitbread added: "We fully endorse [this report's] findings, which reflect our own experiences of taking patients directly to specialist centres to receive primary angioplasty."