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Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013

OBJECTIVE: Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is insufficiently implemented in many countries. We investigated patient and hospital characteristics associated with PPCI utilisation. METHODS: Whole country registry data (MINAP, Myocardial...

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Autores principales: Hall, M, Laut, K, Dondo, T B, Alabas, O A, Brogan, R A, Gutacker, N, Cookson, R, Norman, P, Timmis, A, de Belder, M, Ludman, P F, Gale, C P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752647/
https://www.ncbi.nlm.nih.gov/pubmed/26732182
http://dx.doi.org/10.1136/heartjnl-2015-308616
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author Hall, M
Laut, K
Dondo, T B
Alabas, O A
Brogan, R A
Gutacker, N
Cookson, R
Norman, P
Timmis, A
de Belder, M
Ludman, P F
Gale, C P
author_facet Hall, M
Laut, K
Dondo, T B
Alabas, O A
Brogan, R A
Gutacker, N
Cookson, R
Norman, P
Timmis, A
de Belder, M
Ludman, P F
Gale, C P
author_sort Hall, M
collection PubMed
description OBJECTIVE: Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is insufficiently implemented in many countries. We investigated patient and hospital characteristics associated with PPCI utilisation. METHODS: Whole country registry data (MINAP, Myocardial Ischaemia National Audit Project) comprising PPCI-capable National Health Service trusts in England (84 hospital trusts; 92 350 hospitalisations; 90 489 patients), 2003–2013. Multilevel Poisson regression modelled the relationship between incidence rate ratios (IRR) of PPCI and patient and trust-level factors. RESULTS: Overall, standardised rates of PPCI increased from 0.01% to 86.3% (2003–2013). While, on average, there was a yearly increase in PPCI utilisation of 30% (adjusted IRR 1.30, 95% CI 1.23 to 1.36), it varied substantially between trusts. PPCI rates were lower for patients with previous myocardial infarction (0.95, 0.93 to 0.98), heart failure (0.86, 0.81 to 0.92), angina (0.96, 0.94 to 0.98), diabetes (0.97, 0.95 to 0.99), chronic renal failure (0.89, 0.85 to 0.90), cerebrovascular disease (0.96, 0.93 to 0.99), age >80 years (0.87, 0.85 to 0.90), and travel distances >30 km (0.95, 0.93 to 0.98). PPCI rates were higher for patients with previous percutaneous coronary intervention (1.09, 1.05 to 1.12) and among trusts with >5 interventional cardiologists (1.30, 1.25 to 1.34), more visiting interventional cardiologists (1–5: 1.31, 1.26 to 1.36; ≥6: 1.42, 1.35 to 1.49), and a 24 h, 7-days-a-week PPCI service (2.69, 2.58 to 2.81). Half of the unexplained variation in PPCI rates was due to between-trust differences. CONCLUSIONS: Following an 8 year implementation phase, PPCI utilisation rates stabilised at 85%. However, older and sicker patients were less likely to receive PPCI and there remained between-trust variation in PPCI rates not attributable to differences in staffing levels. Compliance with clinical pathways for STEMI is needed to ensure more equitable quality of care.
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spelling pubmed-47526472016-02-21 Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013 Hall, M Laut, K Dondo, T B Alabas, O A Brogan, R A Gutacker, N Cookson, R Norman, P Timmis, A de Belder, M Ludman, P F Gale, C P Heart Healthcare Delivery, Economics and Global Health OBJECTIVE: Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is insufficiently implemented in many countries. We investigated patient and hospital characteristics associated with PPCI utilisation. METHODS: Whole country registry data (MINAP, Myocardial Ischaemia National Audit Project) comprising PPCI-capable National Health Service trusts in England (84 hospital trusts; 92 350 hospitalisations; 90 489 patients), 2003–2013. Multilevel Poisson regression modelled the relationship between incidence rate ratios (IRR) of PPCI and patient and trust-level factors. RESULTS: Overall, standardised rates of PPCI increased from 0.01% to 86.3% (2003–2013). While, on average, there was a yearly increase in PPCI utilisation of 30% (adjusted IRR 1.30, 95% CI 1.23 to 1.36), it varied substantially between trusts. PPCI rates were lower for patients with previous myocardial infarction (0.95, 0.93 to 0.98), heart failure (0.86, 0.81 to 0.92), angina (0.96, 0.94 to 0.98), diabetes (0.97, 0.95 to 0.99), chronic renal failure (0.89, 0.85 to 0.90), cerebrovascular disease (0.96, 0.93 to 0.99), age >80 years (0.87, 0.85 to 0.90), and travel distances >30 km (0.95, 0.93 to 0.98). PPCI rates were higher for patients with previous percutaneous coronary intervention (1.09, 1.05 to 1.12) and among trusts with >5 interventional cardiologists (1.30, 1.25 to 1.34), more visiting interventional cardiologists (1–5: 1.31, 1.26 to 1.36; ≥6: 1.42, 1.35 to 1.49), and a 24 h, 7-days-a-week PPCI service (2.69, 2.58 to 2.81). Half of the unexplained variation in PPCI rates was due to between-trust differences. CONCLUSIONS: Following an 8 year implementation phase, PPCI utilisation rates stabilised at 85%. However, older and sicker patients were less likely to receive PPCI and there remained between-trust variation in PPCI rates not attributable to differences in staffing levels. Compliance with clinical pathways for STEMI is needed to ensure more equitable quality of care. BMJ Publishing Group 2016-02-15 2016-01-06 /pmc/articles/PMC4752647/ /pubmed/26732182 http://dx.doi.org/10.1136/heartjnl-2015-308616 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Healthcare Delivery, Economics and Global Health
Hall, M
Laut, K
Dondo, T B
Alabas, O A
Brogan, R A
Gutacker, N
Cookson, R
Norman, P
Timmis, A
de Belder, M
Ludman, P F
Gale, C P
Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013
title Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013
title_full Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013
title_fullStr Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013
title_full_unstemmed Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013
title_short Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013
title_sort patient and hospital determinants of primary percutaneous coronary intervention in england, 2003–2013
topic Healthcare Delivery, Economics and Global Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752647/
https://www.ncbi.nlm.nih.gov/pubmed/26732182
http://dx.doi.org/10.1136/heartjnl-2015-308616
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