UNN recommends a PCI center in Northern Norway – if an increase in mortality is detected – NRK Troms and Finnmark

«It is rather worrying that a significant increase in mortality has been detected in patients from Nordlandssykehuset’s admission area​​​​​​”

This is what the University Hospital of Northern Norway (UNN) writes about in its consultation statement The PCI treatment in northern Norway.

In mid-April, the expert committee submitted its report on the PCI offer in Northern Norway.

The report stated that the mortality trend was “statistically significant and in disfavour” for Nordlandssykehuset.

Furthermore, they concluded that the establishment had not resulted in any health benefits.

Prolonged dispute

After many years of tug-of-war, Nordlandssykehuset got its own PCI Center in Bodø in 2020.

Previously, PCI was only available at UNN in Tromsø, and many patients had to be flown in for treatment.

The expert group that evaluated the offer presented its report in April.

The report found that 30-day mortality increased from 5.8 to 7.4 per cent after the establishment of the centre.

In comparison, the establishment at Finnmarkssykehuset, UNN and Helgelandssykehuset led to lower mortality after commencement.

They themselves warn “against drawing firm conclusions”, and point out that the finding may be a random variation.

UNN recommends that further investigations be carried out into what the cause of this is.

«It is unclear what this increased mortality represents», writes UNN.

Figures from the Heart Attack Register, which the committee used in its report, show that Nordlandssykehuset is the only healthcare institution in Northern Norway with an increase in mortality. The increase to 7.4 per cent is lower than the average for the country (7.9 per cent).

All of theirs hospital had an increase. The hospital had the same Sandnessjøen. At UNN Tromsø there was no change between before and after (4.4 per cent).

Disagreement

Nordlandssykehuset itself disagrees with the expert group’s assessment.

They indicate that patients from Lofoten and Vesterålen are treated at UNN. The same applies to patients with urgent needs in their area in the evening, night and weekend, as the hospital does not offer 24-hour services.

This makes up a total of 55 per cent of heart attack patients, according to the hospital.

«The difference in mortality cannot therefore be linked to the PCI center in Nordlandssykehuset», they write in their response.

The hospital further disagrees with the expert group’s findings of no increased health benefits. They consider this “at best a circumvention of the real data and its interpretation”.

Closure

The report revealed that the PCI center had higher costs and lower income than they had calculated.

The offer costs Helse Nord around NOK 20 million extra a year.

The expert group saw two possibilities.

Either the offer should be discontinued, or the offer should continue, but managed from UNN in Tromsø.

The recommendation was to continue the offer on the condition that it be managed from UNN.

The greatest benefit of PCI in Bodø is that many patients do not have to travel for treatment, the committee believes.

Will be controlled from Oslo

UNN itself describes collaboration challenges between the hospitals, and is clear in its conclusion:

«The only sustainable, economically and prioritizing-sound model will therefore be to gather the highly specialized PCI offer in Helse Nord to one location at the University Hospital in Northern Norway».

In the professional communities in Bodø, on the other hand, the aim is to expand the PCI offer to a 24-hour offer.

A cardiologist who previously worked at UNN and now works at Nordlandssykehuset has previously described the PCI offer in Bodø as a great success.

Nordlandssykehuset itself does not want such a solution, given the problems in the professional collaboration. They suggest that a responsible third party can have the power to define and lay down guidelines for the dangerous collaboration.

«Such a third party would naturally be a professional director in Helse Nord RHF (alternatively a professional director in one of the other health regions) or a professional capacity that has not participated in the Expert Group (e.g. from Oslo University Hospital)», writes Nordlandssykehuset.

The mayor of Bodø, Odd Emil Ingebrigtsen (H), is himself well satisfied with the offer. Ingebrigtsen believes maintaining the PCI offer in the city is the only right thing.

– The patient’s best interests must weigh the most. We trust that the professional communities also want it. We expect the professional communities in Bodø and Tromsø to find out how they can organize themselves to ensure a continued good offer in both places, for the benefit of the entire population of Northern Norway, he stated in a press release in mid-April.

– The PCI offer in Bodø must be developed into a 24-hour offer, and that requires good cooperation between UNN and Nordlandssykehuset, he continued.