Aet Saar1, Toomas Marandi2, Tiia Ainla3, Krista Fischer4, Mai Blöndal5, Jaan Eha6. 1. Heart Clinic, University of Tartu, 1a L. Puusepa Str., 50406 Tartu, Estonia; Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Str., 13419 Tallinn, Estonia. Electronic address: aet.saar@regionaalhaigla.ee. 2. Heart Clinic, University of Tartu, 1a L. Puusepa Str., 50406 Tartu, Estonia; Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Str., 13419 Tallinn, Estonia; Quality Department, North Estonia Medical Centre, 19 J. Sütiste Str., 13419 Tallinn, Estonia. Electronic address: toomas.marandi@regionaalhaigla.ee. 3. Heart Clinic, University of Tartu, 1a L. Puusepa Str., 50406 Tartu, Estonia; Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Str., 13419 Tallinn, Estonia. Electronic address: tiia.ainla@regionaalhaigla.ee. 4. Estonian Genome Centre, University of Tartu, 23b Riia Str., 51010 Tartu, Estonia. Electronic address: krista.fischer@ut.ee. 5. Heart Clinic, University of Tartu, 1a L. Puusepa Str., 50406 Tartu, Estonia; Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Str., 13419 Tallinn, Estonia. Electronic address: mai.blondal@ut.ee. 6. Heart Clinic, University of Tartu, 1a L. Puusepa Str., 50406 Tartu, Estonia; Heart Clinic, Tartu University Hospital, 1a L. Puusepa Str., 50406 Tartu, Estonia. Electronic address: jaan.eha@kliinikum.ee.
Abstract
BACKGROUND: The purpose was to describe the treatment and outcomes of non-ST-elevation myocardial infarction (NSTEMI) in Estonia according to patients' estimated mortality risk by the Global Registry of Acute Coronary Events (GRACE) score and investigate if inequalities in treatment had an impact on prognosis. METHODS: We performed a linkage between Estonian Myocardial Infarction Registry, Population Registry and Estonian Health Insurance Fund. All NSTEMI patients 2012-2014 were stratified into low (<4%), intermediate (4-12%), or high (>12%) mortality risk according to GRACE. All-cause mortality and composite endpoint of death, recurrent myocardial infarction, stroke or unplanned revascularization were compared between optimally - defined as concomitant in-hospital use of medicines from recommended groups and coronary angiography - and suboptimally managed patients, using the Cox regression. RESULTS: Out of 3803 NSTEMI patients (median age 73 years, 44% women) 20% were classified into low, 35% into intermediate and 45% into high risk category. In these groups, respectively, 62%, 46% and 23% of patients received optimal in-hospital management. Over the mean follow-up of 2.4 years the association between suboptimal in-hospital management and outcomes was the following: in the low risk group mortality hazard ratio (HR) 1.6 (95% confidence interval 0.8-3.2), composite endpoint HR 1.2 (0.8-1.8); in the intermediate risk group mortality HR 2.4 (1.7-3.3), composite endpoint HR 1.8 (1.4-2.3); and in the high risk group mortality HR 2.2 (1.8-2.8), composite endpoint HR 1.6 (1.3-2.0). CONCLUSIONS: Higher risk NSTEMI patients received less guideline-recommended in-hospital management, which was associated with a worse prognosis.
BACKGROUND: The purpose was to describe the treatment and outcomes of non-ST-elevation myocardial infarction (NSTEMI) in Estonia according to patients' estimated mortality risk by the Global Registry of Acute Coronary Events (GRACE) score and investigate if inequalities in treatment had an impact on prognosis. METHODS: We performed a linkage between Estonian Myocardial Infarction Registry, Population Registry and Estonian Health Insurance Fund. All NSTEMI patients 2012-2014 were stratified into low (<4%), intermediate (4-12%), or high (>12%) mortality risk according to GRACE. All-cause mortality and composite endpoint of death, recurrent myocardial infarction, stroke or unplanned revascularization were compared between optimally - defined as concomitant in-hospital use of medicines from recommended groups and coronary angiography - and suboptimally managed patients, using the Cox regression. RESULTS: Out of 3803 NSTEMI patients (median age 73 years, 44% women) 20% were classified into low, 35% into intermediate and 45% into high risk category. In these groups, respectively, 62%, 46% and 23% of patients received optimal in-hospital management. Over the mean follow-up of 2.4 years the association between suboptimal in-hospital management and outcomes was the following: in the low risk group mortality hazard ratio (HR) 1.6 (95% confidence interval 0.8-3.2), composite endpoint HR 1.2 (0.8-1.8); in the intermediate risk group mortality HR 2.4 (1.7-3.3), composite endpoint HR 1.8 (1.4-2.3); and in the high risk group mortality HR 2.2 (1.8-2.8), composite endpoint HR 1.6 (1.3-2.0). CONCLUSIONS: Higher risk NSTEMI patients received less guideline-recommended in-hospital management, which was associated with a worse prognosis.
Authors: Niels M R van der Sangen; Jaouad Azzahhafi; Dean R P P Chan Pin Yin; Joyce Peper; Senna Rayhi; Ronald J Walhout; Melvyn Tjon Joe Gin; Deborah M Nicastia; Jorina Langerveld; Georgios J Vlachojannis; Rutger J van Bommel; Yolande Appelman; José P S Henriques; Jurriën M Ten Berg; Wouter J Kikkert Journal: Open Heart Date: 2022-03
Authors: Janice Gullick; John Wu; Derek Chew; Chris Gale; Andrew T Yan; Shaun G Goodman; Donna Waters; Karice Hyun; David Brieger Journal: BMC Health Serv Res Date: 2022-03-22 Impact factor: 2.655