OBJECTIVE: To examine process of care and outcome for patients admitted with acute myocardial infarction to hospitals in England and Wales in relation to type of consultant care and type of hospital. DESIGN: Observational study of 88,782 patients admitted with myocardial infarction during 2004-5, using records from the national audit of myocardial infarction project (MINAP) database. OUTCOME MEASURES: Use of reperfusion treatment and secondary prevention drugs, use of angiography, and 90 day mortality of patients admitted under the care of cardiologists and non-cardiologists in hospitals with and without facilities for coronary intervention. FINDINGS: 36% of patients were admitted under the care of a cardiologist and 20% to a hospital with coronary interventional facilities. Patients admitted under cardiologists had fewer comorbidities than other patients and were more likely to have reperfusion treatment (12,266/14,433 (85%) v 13,682/17,064 (80%)) and appropriate secondary prevention drugs. Overall, 27,431/79,374 (35%) of patients had angiography. Relatively more patients admitted to interventional hospitals (8167/14,661; 56%) than to other hospitals had angiography (19,264/64,713; 30%). The adjusted risk of death by 90 days for patients treated in interventional compared with non-interventional hospitals was 0.93 (95% confidence interval 0.82 to 1.06). The adjusted risk of death at 90 days for patients admitted under cardiologists compared with non-cardiologists was 0.86 (0.81 to 0.91). CONCLUSIONS: Patients cared for by cardiologists had less comorbidity than other patients. They were more likely to receive proved treatments and angiography, and they had a lower adjusted 90 day mortality. Large differences existed in the use of angiography between interventional and non-interventional hospitals. These findings show wide variations in the management and outcome of patients with myocardial infarction in England and Wales.
OBJECTIVE: To examine process of care and outcome for patients admitted with acute myocardial infarction to hospitals in England and Wales in relation to type of consultant care and type of hospital. DESIGN: Observational study of 88,782 patients admitted with myocardial infarction during 2004-5, using records from the national audit of myocardial infarction project (MINAP) database. OUTCOME MEASURES: Use of reperfusion treatment and secondary prevention drugs, use of angiography, and 90 day mortality of patients admitted under the care of cardiologists and non-cardiologists in hospitals with and without facilities for coronary intervention. FINDINGS: 36% of patients were admitted under the care of a cardiologist and 20% to a hospital with coronary interventional facilities. Patients admitted under cardiologists had fewer comorbidities than other patients and were more likely to have reperfusion treatment (12,266/14,433 (85%) v 13,682/17,064 (80%)) and appropriate secondary prevention drugs. Overall, 27,431/79,374 (35%) of patients had angiography. Relatively more patients admitted to interventional hospitals (8167/14,661; 56%) than to other hospitals had angiography (19,264/64,713; 30%). The adjusted risk of death by 90 days for patients treated in interventional compared with non-interventional hospitals was 0.93 (95% confidence interval 0.82 to 1.06). The adjusted risk of death at 90 days for patients admitted under cardiologists compared with non-cardiologists was 0.86 (0.81 to 0.91). CONCLUSIONS:Patients cared for by cardiologists had less comorbidity than other patients. They were more likely to receive proved treatments and angiography, and they had a lower adjusted 90 day mortality. Large differences existed in the use of angiography between interventional and non-interventional hospitals. These findings show wide variations in the management and outcome of patients with myocardial infarction in England and Wales.
Authors: Michel E Bertrand; Maarten L Simoons; Keith A A Fox; Lars C Wallentin; Christian W Hamm; Eugene McFadden; Pim J De Feyter; Giuseppe Specchia; Witold Ruzyllo Journal: Eur Heart J Date: 2002-12 Impact factor: 29.983
Authors: Frans Van de Werf; Joel M Gore; Alvaro Avezum; Dietrich C Gulba; Shaun G Goodman; Andrzej Budaj; David Brieger; Kami White; Keith A A Fox; Kim A Eagle; Brian M Kennelly Journal: BMJ Date: 2005-01-21
Authors: K A A Fox; P A Poole-Wilson; R A Henderson; T C Clayton; D A Chamberlain; T R D Shaw; D J Wheatley; S J Pocock Journal: Lancet Date: 2002-09-07 Impact factor: 79.321
Authors: Frans Van de Werf; Diego Ardissino; Amadeo Betriu; Dennis V Cokkinos; Erling Falk; Keith A A Fox; Desmond Julian; Maria Lengyel; Franz-Josef Neumann; Witold Ruzyllo; Christian Thygesen; S Richard Underwood; Alec Vahanian; Freek W A Verheugt; William Wijns Journal: Eur Heart J Date: 2003-01 Impact factor: 29.983
Authors: Richard G Bach; Christopher P Cannon; William S Weintraub; Peter M DiBattiste; Laura A Demopoulos; H Vernon Anderson; Paul T DeLucca; Elizabeth M Mahoney; Sabina A Murphy; Eugene Braunwald Journal: Ann Intern Med Date: 2004-08-03 Impact factor: 25.391
Authors: Eugene Braunwald; Elliott M Antman; John W Beasley; Robert M Califf; Melvin D Cheitlin; Judith S Hochman; Robert H Jones; Dean Kereiakes; Joel Kupersmith; Thomas N Levin; Carl J Pepine; John W Schaeffer; Earl E Smith; David E Steward; Pierre Theroux; Raymond J Gibbons; Joseph S Alpert; David P Faxon; Valentin Fuster; Gabriel Gregoratos; Loren F Hiratzka; Alice K Jacobs; Sidney C Smith Journal: Circulation Date: 2002-10-01 Impact factor: 29.690
Authors: Ibrahim Al-Zakwani; Mohammad Zubaid; Adil Al-Riyami; Muath Alanbaei; Kadhim Sulaiman; Wael Almahmeed; Ahmed Al-Motarreb; Jassim Al Suwaidi Journal: Int J Clin Pharm Date: 2012-04-03
Authors: Vivek T Kulkarni; Joseph S Ross; Yongfei Wang; Brahmajee K Nallamothu; John A Spertus; Sharon-Lise T Normand; Frederick A Masoudi; Harlan M Krumholz Journal: Circ Cardiovasc Qual Outcomes Date: 2013-05-16
Authors: Alexander D Simms; Philip D Batin; John Kurian; Nigel Durham; Christopher P Gale Journal: J Geriatr Cardiol Date: 2012-06 Impact factor: 3.327
Authors: Emil L Fosbol; DaJuanicia N Holmes; Jonathan P Piccini; Laine Thomas; James A Reiffel; Roger M Mills; Peter Kowey; Kenneth Mahaffey; Bernard J Gersh; Eric D Peterson Journal: J Am Heart Assoc Date: 2013-07-18 Impact factor: 5.501