Half of heart attacks occur in patients told they are not at risk

Telegraph

19-07-2025

Most heart attacks occur in patients who were falsely reassured they were in good cardiac health, research has found.
New NHS pilot schemes using artificial intelligence have revealed that almost half of at-risk patients are being missed by standard diagnostic tests.
Early findings from pilot schemes at five NHS trusts shows almost half of patients had their treatment plans changed after their scans were reassessed using the new technology - with far more being put on statins.
Prof Simon Ray, Britain's top heart doctor, said the new AI tool, which assesses standard heart scans, could be 'a complete game-changer'. The NHS chief added that the use of 'incredibly clever scans' could find warning signs that were otherwise undetectable and 'turbocharge' efforts to save lives.
Research found the technology can reduce fatal heart attacks by 12 per cent – and cut other serious events like strokes and heart failure by nearly a third.
Every year, around 300,000 people in the UK undergo coronary CT scans after suffering problems such as chest pains or breathlessness. Around 80 per cent are told there's little or nothing to worry about.
But in the years that follow, two-thirds of heart attacks happen in that same group, research has found.
Now, the new technology is offering a clearer picture.
The AI tool, developed by medics from Oxford, can spot dangerous inflammation in the fat around the arteries – something invisible to the human eye.
Cardiologists said far too many patients were currently being 'wrongly reassured' that they had no problem, after being referred for scans because of cardiac symptoms.
The AI analysis was able to identify far more patients who could benefit from treatments such as statins, and to pick out those who needed a higher dose, or other forms of treatment.
Medics said that patients were also far more likely to take their tablets, or make necessary lifestyle changes, after seeing their risk of a fatal cardiac risk, backed by images showing the inflammation around the arteries.
The technology was developed by Oxford spinout company Caristo Diagnostics, co-founded by Prof Charalambos Antoniades, the University of Oxford chair of cardiovascular medicine, with grant funding from the British Heart Foundation.
Prof Antoniades said the impact of the breakthrough could be 'massive' given that most heart attacks come from patients who have undergone scans, only to be told they have little to worry about.
The leading cardiologist said: 'Two thirds of the heart attacks happen among those 80 per cent of people who have been reassured'.
He said: 'Every year, around 300,000 patients are having coronary CT scans; we are finding that approximately 45 per cent of the individuals that have these scans today in the NHS are being under-treated, and underdiagnosed; they are being reassured wrongly that they have no problem, and essentially they are discharged.
'These are exactly the patients that we identify; and we guide them towards preventive treatments so that we we can reduce risk.'
The new tool, which analyses conventional scans, at a cost of around £270 per case, is able to detect far more subtle changes in the fat around the coronary arteries, which result in plaque rupture and heart attacks.
Pilot schemes at Oxford University Hospitals NHS Foundation trust, Liverpool Heart and Chest Hospitals NHS Foundation trust, University Hospitals of Leicester NHS Trust, Milton Keynes University Hospital NHS Foundation trust and Royal Wolverhampton NHS trust, funded by NHS England, have now assessed 1425 scans, using the 'CaRI-Heart' AI analysis.
Patients who were shown the detailed images were also far more likely to comply with treatment regimes, and to overhaul their lifestyles, medics found.
Heart disease is the one of the biggest killers in the UK, with one in eight men and one in 14 women dying from coronary heart disease.
Analysis suggests that using the technology in 300,000 patients a year would prevent almost 5,760 heart attacks, 7,740 cardiac deaths, 4080 heart failures and 1,320 strokes; meaning almost 19,000 cardiovascular events prevented in total.
Prof Ray, NHS national clinical director for heart disease, said: ' Heart disease is one of our biggest killers and this new tool could be a complete game-changer based on its early findings – using incredibly clever scans to spot inflammation in the arteries that was previously undetectable and helping turbocharge NHS efforts on prevention.
'By using technology like AI to support clinicians and enhance the care our expert teams can offer, we can help more people lead healthier lives and potentially prevent thousands of serious health incidents like heart attacks and strokes, which is fantastic for patients and their families and vital for the NHS as we move from treatment to prevention as part of the 10 Year Health Plan.'
'Traffic light' assessment system
Dr Tim Fairbairn, a cardiologist at Liverpool Heart and Chest Hospital, said the technology could provide medics with a simple 'traffic light' assessment of risk, informing decisions about medications and lifestyle.
'This a patient group which is already being investigated for coronary artery disease – so its patients with chest pains, angina, breathlessness; this is about preventing future events such as heart attacks.'
The leading medic said the NHS was good at dealing with patients with the most obvious signs of blocked arteries but struggled to identify the vast majority of patients at increased risk.
Dr Fairburn said: 'A lot of the rest will be told you're fine, don't worry and that can mean they don't change their diet, they carry on smoking, they don't increase their exercise. We need to be more aggressive about treating these cases and helping people to change their lifestyles.'
The new technology can spot details on scans which cannot be seen by the human eye, in an assessment which also takes account of other clinical data, such as cholesterol levels.
The cardiologist said the pilot NHS schemes has shown the technology could dramatically change not just the decisions being made by doctors, but also by patients.
The National Institute for Health and Care Excellence is currently evaluating the new technology, meaning it could be rolled out far more widely.