Muhammad Rashid1, Nick Curzen2, Tim Kinnaird3, Claire A Lawson4, Phyo K Myint5, Evangelos Kontopantelis6, Mohamed O Mohamed7, Ahmad Shoaib7, Chris P Gale8, Adam Timmis9, Mamas A Mamas7. 1. Keele Cardiovascular Research group, Centre of Prognosis Research, Institute of Primary Care Sciences, Keele University, Stoke on Trent, UK; Department of Cardiology, University Hospital of North Midlands, Stoke on Trent, UK. Electronic address: doctorrashid7@gmail.com. 2. Coronary Research Group, University Hospital Southampton & Faculty of Medicine, University of Southampton, UK. 3. Department of Cardiology, University Hospital of Wales, Cardiff, UK. 4. Real World Evidence Unit, Diabetes Research Centre, University of Leicester, UK. 5. Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK. 6. University of Manchester, Division of Population Health, Health Services Research and Primary Care, Manchester, UK. 7. Keele Cardiovascular Research group, Centre of Prognosis Research, Institute of Primary Care Sciences, Keele University, Stoke on Trent, UK; Department of Cardiology, University Hospital of North Midlands, Stoke on Trent, UK. 8. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. 9. Barts Heart Centre, Queen Mary University London, UK.
Abstract
BACKGROUND: International guidelines recommend that for NSTEMI, the timing of invasive strategy (IS) is a function of patient's baseline risk. The extent to which this is delivered across and within healthcare systems is unknown. METHODS: Data were derived from 137,265 patients admitted with an NSTEMI diagnosis between 2010 and 2015 in England and Wales. Patients were stratified into low, intermediate and high-risk in keeping with international guidelines. Time to IS was categorised into early (24 h), intermediate (25-72 h) and late (>72 h). Multivariable logistic regression models were used to identify independent predictors of guidelines recommended receipt of IS. RESULTS: There were 3608 (2.6%) low, 5037 (3.7%) intermediate and 128,621 (93.7%) high-risk patients. Guidelines recommended use of IS was significantly lower in high-risk (16.4%) compared to intermediate (64.7%) and low-risk (62.5%) groups. Both men and women in the low-risk category were almost twice as likely to receive early IS compared to high-risk men (28.9% vs 17%, p < 0.001) and women (26.9% vs 15%, p < 0.001). Women (OR 0.91 95%CI 0.88-0.94), troponin elevation (OR 0.39 95%CI 0.36-0.43) and acute heart failure on admission (OR 0.65 95%CI 0.61-0.70) were strong negative predictors of receiving IS within recommended time in the high-risk group. CONCLUSION: Our study shows that IS for management of NSTEMI is not delivered according to international guidelines recommendations. Specifically, the disconnect between baseline risk and utility of IS increases with increasing risk and women achieve slower access than men to IS.
BACKGROUND: International guidelines recommend that for NSTEMI, the timing of invasive strategy (IS) is a function of patient's baseline risk. The extent to which this is delivered across and within healthcare systems is unknown. METHODS: Data were derived from 137,265 patients admitted with an NSTEMI diagnosis between 2010 and 2015 in England and Wales. Patients were stratified into low, intermediate and high-risk in keeping with international guidelines. Time to IS was categorised into early (24 h), intermediate (25-72 h) and late (>72 h). Multivariable logistic regression models were used to identify independent predictors of guidelines recommended receipt of IS. RESULTS: There were 3608 (2.6%) low, 5037 (3.7%) intermediate and 128,621 (93.7%) high-risk patients. Guidelines recommended use of IS was significantly lower in high-risk (16.4%) compared to intermediate (64.7%) and low-risk (62.5%) groups. Both men and women in the low-risk category were almost twice as likely to receive early IS compared to high-risk men (28.9% vs 17%, p < 0.001) and women (26.9% vs 15%, p < 0.001). Women (OR 0.91 95%CI 0.88-0.94), troponin elevation (OR 0.39 95%CI 0.36-0.43) and acute heart failure on admission (OR 0.65 95%CI 0.61-0.70) were strong negative predictors of receiving IS within recommended time in the high-risk group. CONCLUSION: Our study shows that IS for management of NSTEMI is not delivered according to international guidelines recommendations. Specifically, the disconnect between baseline risk and utility of IS increases with increasing risk and women achieve slower access than men to IS.
Authors: Saadiq M Moledina; Ahmad Shoaib; Louise Y Sun; Phyo K Myint; Rafail A Kotronias; Benoy N Shah; Chris P Gale; Hude Quan; Rodrigo Bagur; Mamas A Mamas Journal: Eur Heart J Qual Care Clin Outcomes Date: 2022-09-05
Authors: Muhammad Rashid; Jianhua Wu; Adam Timmis; Nick Curzen; Sarah Clarke; Azfar Zaman; James Nolan; Ahmad Shoaib; Mohamed O Mohamed; Mark A de Belder; John Deanfield; Chris P Gale; Mamas A Mamas Journal: J Intern Med Date: 2021-03-13 Impact factor: 13.068
Authors: Ahmad Shoaib; Muhammad Rashid; Colin Berry; Nick Curzen; Evangelos Kontopantelis; Adam Timmis; Ayesha Ahmad; Tim Kinnaird; Mamas A Mamas Journal: J Am Heart Assoc Date: 2021-10-06 Impact factor: 5.501
Authors: Andrija Matetic; Warkaa Shamkhani; Muhammad Rashid; Annabelle Santos Volgman; Harriette G C Van Spall; Thais Coutinho; Laxmi S Mehta; Garima Sharma; Purvi Parwani; Mohamed Osama Mohamed; Mamas A Mamas Journal: CJC Open Date: 2021-07-01
Authors: Mohamed Dafaalla; Muhammad Rashid; Rachel M Bond; Triston Smith; Purvi Parwani; Ritu Thamman; Saadiq M Moledina; Michelle M Graham; Mamas A Mamas Journal: CJC Open Date: 2021-10-02
Authors: Thomas A Kite; Sameer A Kurmani; Vasiliki Bountziouka; Nicola J Cooper; Selina T Lock; Chris P Gale; Marcus Flather; Nick Curzen; Adrian P Banning; Gerry P McCann; Andrew Ladwiniec Journal: Eur Heart J Date: 2022-09-01 Impact factor: 35.855
Authors: Muhammad Rashid Hons; Chris P Gale Hons; Nick Curzen Hons; Peter Ludman Hons; Mark De Belder Hons; Adam Timmis Hons; Mohamed O Mohamed Hons; Thomas F Lüscher Hons; Julian Hains Hons; Jianhua Wu; Ahmad Shoaib; Evangelos Kontopantelis; Chris Roebuck; Tom Denwood; John Deanfield; Mamas A Mamas Journal: J Am Heart Assoc Date: 2020-10-07 Impact factor: 5.501