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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...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2016
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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. |
format | Online Article Text |
id | pubmed-4752647 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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