BACKGROUND: Internationally, differences have been noted in how specialist cardiologists and general physicians manage acute coronary syndromes (ACS). Whether a similar practice difference exists in New Zealand is unclear. AIM: To test the hypothesis that management differences exist between cardiologists and general physicians in patients presenting with a non-ST-segment elevation acute coronary syndrome in a New Zealand setting-and whether these differences (if present) impact on patient outcome. METHODS: A retrospective chart review of 324 consecutive patients presenting with a non-ST-segment elevation acute coronary syndrome to Taranaki Base and Waikato Hospitals from 1 January 1999 was undertaken. Patients in Taranaki were managed by general physicians and in Waikato they were managed by cardiologists. RESULTS: Patients presenting to Taranaki Base Hospital were more likely to have high-risk ECG changes with ST-segment depression noted in 34.4% of patients there compared to 16.8% of patients in Waikato (p<0.001). Medical management during patient stabilisation was similar in Taranaki and Waikato with high use of anti-thrombotic (89%) and anti-platelet therapy (94%), respectively. However angiography (5.1% versus 23.4%; p=0.0045) and revascularisation procedures (4% versus 16.7%; p=0.0002) were performed less frequently in Taranaki. No significant difference was noted in mortality at 6 months (9.6% in Waikato versus 13.4% in Taranaki; p=0.4) Readmission rates were also similar; occurring overall in approximately one-quarter of the study population. CONCLUSION: In New Zealand, differences exist in how cardiologists and general physicians manage non-ST-elevation acute coronary syndrome. In particular, the low referral rates for angiography by general physicians is of concern and requires correction as current best-practice guidelines suggest high-risk patients are disadvantaged by a conservative approach to management.
BACKGROUND: Internationally, differences have been noted in how specialist cardiologists and general physicians manage acute coronary syndromes (ACS). Whether a similar practice difference exists in New Zealand is unclear. AIM: To test the hypothesis that management differences exist between cardiologists and general physicians in patients presenting with a non-ST-segment elevation acute coronary syndrome in a New Zealand setting-and whether these differences (if present) impact on patient outcome. METHODS: A retrospective chart review of 324 consecutive patients presenting with a non-ST-segment elevation acute coronary syndrome to Taranaki Base and Waikato Hospitals from 1 January 1999 was undertaken. Patients in Taranaki were managed by general physicians and in Waikato they were managed by cardiologists. RESULTS:Patients presenting to Taranaki Base Hospital were more likely to have high-risk ECG changes with ST-segment depression noted in 34.4% of patients there compared to 16.8% of patients in Waikato (p<0.001). Medical management during patient stabilisation was similar in Taranaki and Waikato with high use of anti-thrombotic (89%) and anti-platelet therapy (94%), respectively. However angiography (5.1% versus 23.4%; p=0.0045) and revascularisation procedures (4% versus 16.7%; p=0.0002) were performed less frequently in Taranaki. No significant difference was noted in mortality at 6 months (9.6% in Waikato versus 13.4% in Taranaki; p=0.4) Readmission rates were also similar; occurring overall in approximately one-quarter of the study population. CONCLUSION: In New Zealand, differences exist in how cardiologists and general physicians manage non-ST-elevation acute coronary syndrome. In particular, the low referral rates for angiography by general physicians is of concern and requires correction as current best-practice guidelines suggest high-risk patients are disadvantaged by a conservative approach to management.