Saadiq M Moledina1, Ahmad Shoaib1, Michelle M Graham2, Giuseppe Biondi-Zoccai3,4, Harriette G C Van Spall5,6, Evangelos Kontopantelis7, Muhammad Rashid1, Suleman Aktaa8,9,10, Chris P Gale8,9,10, Clive Weston11, Mamas A Mamas1. 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK. 2. Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. 3. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. 4. Mediterranea Cardiocentro, Napoli, Italy. 5. Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. 6. Department of Health Research Methods, Evidence, and Impact, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. 7. Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK. 8. Leeds Institute for Data Analytics, University of Leeds, Leeds, UK. 9. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. 10. Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 11. Glangwili General Hospital, Carmarthen, Wales, UK.
Abstract
AIM: Little is known about the association between admitting physician specialty and care quality and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). METHODS AND RESULTS: We identified 288 420 patients hospitalized with NSTEMI between 2010 and 2017 in the UK Myocardial Infarction National Audit Project database. The cohort was dichotomized according to care under a non-cardiologist (n = 146 722) and care under a cardiologist (n = 141 698) within the first 24 h of admission to hospital. Patients admitted under a cardiologist were significantly younger (70 vs. 75 years, P < 0.001), and less likely to be female (32% vs. 39%, P < 0.001). Independent factors associated with admission under a cardiologist included prior history of percutaneous coronary intervention (PCI) [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07; P = 0.04], hypercholesterolaemia (OR 1.17, 95% CI 1.15-1.20; P < 0.001), hypertension (OR 1.03, 95% CI 1.01-1.04; P = 0.01), and admission to an interventional centre (OR 3.90, 95% CI 3.79-4.00; P < 0.001). Patients admitted under cardiology were more likely to receive optimal pharmacotherapy, undergo invasive coronary angiography (79% vs. 60%, P < 0.001), and receive revascularization in the form of PCI (52% vs. 36%, P < 0.001). Following propensity score matching, odds of in-hospital all-cause mortality (OR 0.81, 95% CI 0.79-0.85; P < 0.001), re-infarction (OR 0.78, 95% CI 0.66-0.91; P = 0.001), and major adverse cardiovascular events (OR 0.81, 95% CI 0.78-0.84; P < 0.001) were lower in patients admitted under a cardiologist. CONCLUSION: Patients with NSTEMI admitted under a cardiologist within 24 h of hospital admission were more likely to receive guideline-directed management and had better clinical outcomes. Published on behalf of the European Society of Cardiology. All rights reserved.
AIM: Little is known about the association between admitting physician specialty and care quality and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). METHODS AND RESULTS: We identified 288 420 patients hospitalized with NSTEMI between 2010 and 2017 in the UK Myocardial Infarction National Audit Project database. The cohort was dichotomized according to care under a non-cardiologist (n = 146 722) and care under a cardiologist (n = 141 698) within the first 24 h of admission to hospital. Patients admitted under a cardiologist were significantly younger (70 vs. 75 years, P < 0.001), and less likely to be female (32% vs. 39%, P < 0.001). Independent factors associated with admission under a cardiologist included prior history of percutaneous coronary intervention (PCI) [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07; P = 0.04], hypercholesterolaemia (OR 1.17, 95% CI 1.15-1.20; P < 0.001), hypertension (OR 1.03, 95% CI 1.01-1.04; P = 0.01), and admission to an interventional centre (OR 3.90, 95% CI 3.79-4.00; P < 0.001). Patients admitted under cardiology were more likely to receive optimal pharmacotherapy, undergo invasive coronary angiography (79% vs. 60%, P < 0.001), and receive revascularization in the form of PCI (52% vs. 36%, P < 0.001). Following propensity score matching, odds of in-hospital all-cause mortality (OR 0.81, 95% CI 0.79-0.85; P < 0.001), re-infarction (OR 0.78, 95% CI 0.66-0.91; P = 0.001), and major adverse cardiovascular events (OR 0.81, 95% CI 0.78-0.84; P < 0.001) were lower in patients admitted under a cardiologist. CONCLUSION: Patients with NSTEMI admitted under a cardiologist within 24 h of hospital admission were more likely to receive guideline-directed management and had better clinical outcomes. Published on behalf of the European Society of Cardiology. All rights reserved.
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