Few would deny that the management of acute myocardial infarction (AMI) has improved significantly since the introduction of National Service Framework standards in 2000. But are we truly delivering the best care achievable to every individual?

According to the most recent report from the Myocardial Infarction National Audit Project, 58% of patients with AMI in England are now receiving thrombolytic treatment within 60 min of calling for professional help compared with just 22% in early 2001.¹ The proportion of patients receiving thrombolytic treatment within 30 min of arrival at hospital has almost doubled over this time (from 44% in 2001 to 83% in 2006), and 88% of hospitals now provide thrombolytic treatments to 75% of their eligible patients within 30 min of the patient’s arrival at hospital. With similar standards of excellence being met in the provision of secondary prevention medication (97% of patients with AMI receive aspirin, 92% receive β-blockers and 96% receive statins), there seems to be much to support the recent statement from the National Director for Heart Disease, Roger Boyle, that “Patients with heart attack are being treated at a level of excellence that is unsurpassed anywhere in Europe or beyond.”¹

The difficulty, of course, will be to maintain the impressive momentum that we have built up over the past 5 years. Indeed, there is already evidence that the pace of progress is slowing down. In the past 2 years, there has been improvement neither in door-to-needle times nor in the percentage of hospitals providing thrombolytic treatment to 75% of eligible patients.

Roger Boyle claims that this is because “it is difficult to improve on services that are already near to the optimum”. But it is …