The impact of specialist cardiology inpatient care on the long-term outcomes of non-ST-segment elevation myocardial infarction (NSTEMI): A nationwide cohort study.

Moledina, Saadiq M; Weight, Nicholas; Cole, Andrew; Rashid, Muhammad; Kontopantelis, Evangelos; Mamas, Mamas A

Abstract

Specialist cardiac care has been shown to reduce inpatient mortality following non-ST segment myocardial infarction (NSTEMI), but whether this benefit extends beyond index admission is unclear. Using the linked Myocardial Ischaemia National Audit Project (MINAP) registry, and Office for National Statistics mortality recording, we included 425,205 NSTEMI patients admitted to UK hospitals, between January 2005 and March 2019 that survived to discharge. 217,964 (52 %) were admitted to a specialty cardiac ward. Multivariable Cox-regression models were applied to imputed data to estimate Hazard Ratios for mortality over our study period. Patients admitted to specialty cardiology wards were younger (70 years vs. 75), less often female (32 % vs. 40 %) but more often received statins (86 % vs. 84 %) or beta-blockers (83 % vs. 77 %) (all P < 0.001). One-year (aHR:0.84, 95 % CI 0.83-0.86), and ten-year mortality (aHR: 0.88, 95 % CI 0.87-0.89) were lower in patients admitted to specialty cardiac wards, compared to admitted elsewhere (all P < 0.001). There was significant geographic variation in the proportion admitted to speciality cardiac wards (London 59 % vs. East of England 43 %), with over 1700 deaths potentially avoided if the MINAP target of 80 % was reached. Patients admitted to a cardiac ward had significantly lower mortality compared to alternate wards persisting up to ten-years. There is wide regional variation in the proportion of patients who received specialist cardiology care during their admission and an opportunity exists for lives saved if the proportion of NSTEMI patients admitted to a cardiac ward were to reach the MINAP target of 80 %. [Abstract copyright: Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.]

Citation

Moledina, S. M., Weight, N., Cole, A., Rashid, M., Kontopantelis, E., & Mamas, M. A. (in press). The impact of specialist cardiology inpatient care on the long-term outcomes of non-ST-segment elevation myocardial infarction (NSTEMI): A nationwide cohort study. International Journal of Cardiology, 423, 1-10. https://doi.org/10.1016/j.ijcard.2025.132990

• Journal Article Type: Article
• Acceptance Date: Jan 13, 2025
• Online Publication Date: Jan 16, 2025
• Deposit Date: Feb 6, 2025
• Journal: International journal of cardiology
• Print ISSN: 0167-5273
• Electronic ISSN: 1874-1754
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 423
• Article Number: 132990
• Pages: 1-10
• DOI: https://doi.org/10.1016/j.ijcard.2025.132990
• Keywords: Mortality, Ward, CCU, NSTEMI
• Public URL: https://keele-repository.worktribe.com/output/1053612