Impact of the admitting ward on care quality and outcomes in non-ST-segment elevation myocardial infarction (NSTEMI): insights from a national registry.

Mamas

Abstract

BACKGROUND: Little is known about the association between the type of admission ward and quality of care and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). METHODS & RESULTS: We analysed data from 337,155 NSTEMI admissions between 2010-2017 in the United Kingdom (UK) Myocardial Ischaemia National Audit Project (MINAP) database. The cohort was dichotomised according to receipt of care either on a medical (n = 142,876) or cardiac ward, inclusive of acute cardiac wards and cardiac care unit (n = 194,279) on admission to hospital. Patients admitted to a cardiac ward were younger (median age 70y vs 75y, P < 0.001), and less likely to be female (33% vs 40%, P < 0.001). Independent factors associated with admission to a cardiac ward included ischaemic ECG changes (OR: 1.20, 95% CI: 1.18-1.23) and prior percutaneous coronary intervention (PCI) (OR: 1.19, 95% CI: 1.16-1.22). Patients admitted to a cardiac ward were more likely to receive optimal pharmacotherapy with statin (85% vs 81%, P < 0.001) and dual antiplatelet therapy (DAPT) (91% vs 88%, P < 0.001) on discharge, undergo invasive coronary angiography (78% vs 59%, P < 0.001) and receive revascularisation in the form of PCI (52% vs 36%, P < 0.001). Following multivariable logistic regression, the odds of in-hospital all-cause mortality (OR: 0.75, 95% CI: 0.70-0.81) and major adverse cardiovascular events (MACE) (OR: 0.84, 95% CI: 0.78-0.91) were lower in patients admitted to a cardiac ward. CONCLUSION: Patients with NSTEMI admitted to a cardiac ward on admission were more likely to receive guideline directed management and had better clinical outcomes.

Citation

Mamas. (2021). Impact of the admitting ward on care quality and outcomes in non-ST-segment elevation myocardial infarction (NSTEMI): insights from a national registry. European Heart Journal - Quality of Care and Clinical Outcomes, https://doi.org/10.1093/ehjqcco/qcab062

• Acceptance Date: Sep 2, 2021
• Publication Date: Sep 4, 2021
• Journal: European Heart Journal - Quality of Care and Clinical Outcomes
• Print ISSN: 2058-5225
• Publisher: Oxford University Press
• DOI: https://doi.org/10.1093/ehjqcco/qcab062
• Keywords: NSTEMI; Cardiac Ward; CCU; Mortality
• Publisher URL: https://academic.oup.com/ehjqcco/advance-article/doi/10.1093/ehjqcco/qcab062/6364357