Saadiq M Moledina1, Ahmad Shoaib1, Louise Y Sun2, Phyo K Myint3, Rafail A Kotronias4, Benoy N Shah5, Chris P Gale6, Hude Quan7, Rodrigo Bagur1, Mamas A Mamas1. 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK. 2. Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 3. Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK. 4. Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, UK. 5. Department of Cardiology, Wessex Cardiac Centre, University Hospital Southampton, Southampton, UK. 6. Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. 7. Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.
Abstract
AIMS: Little is known about the association between the type of admission ward and quality of care and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). METHODS AND RESULTS: We analysed data from 337 155 NSTEMI admissions between 2010 and 2017 in the UK Myocardial Ischaemia National Audit Project (MINAP) database. The cohort was dichotomised according to receipt of care either on a medical (n = 142,876) or cardiac ward, inclusive of acute cardiac wards and cardiac care unit (n = 194,279) on admission to hospital. Patients admitted to a cardiac ward were younger (median age 70 y vs. 75 y, P < 0.001), and less likely to be female (33% vs. 40%, P < 0.001). Independent factors associated with admission to a cardiac ward included ischaemic ECG changes (OR: 1.20, 95% CI: 1.18-1.23) and prior percutaneous coronary intervention (PCI) (OR: 1.19, 95% CI: 1.16-1.22). Patients admitted to a cardiac ward were more likely to receive optimal pharmacotherapy with statin (85% vs. 81%, P < 0.001) and dual antiplatelet therapy (DAPT) (91% vs. 88%, P < 0.001) on discharge, undergo invasive coronary angiography (78% vs. 59%, P < 0.001), and receive revascularisation in the form of PCI (52% vs. 36%, P < 0.001). Following multivariable logistic regression, the odds of inhospital all-cause mortality (OR: 0.75, 95% CI: 0.70-0.81) and major adverse cardiovascular events (MACE) (OR: 0.84, 95% CI: 0.78-0.91) were lower in patients admitted to a cardiac ward. CONCLUSION: Patients with NSTEMI admitted to a cardiac ward on admission were more likely to receive guideline directed management and had better clinical outcomes.
AIMS: Little is known about the association between the type of admission ward and quality of care and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). METHODS AND RESULTS: We analysed data from 337 155 NSTEMI admissions between 2010 and 2017 in the UK Myocardial Ischaemia National Audit Project (MINAP) database. The cohort was dichotomised according to receipt of care either on a medical (n = 142,876) or cardiac ward, inclusive of acute cardiac wards and cardiac care unit (n = 194,279) on admission to hospital. Patients admitted to a cardiac ward were younger (median age 70 y vs. 75 y, P < 0.001), and less likely to be female (33% vs. 40%, P < 0.001). Independent factors associated with admission to a cardiac ward included ischaemic ECG changes (OR: 1.20, 95% CI: 1.18-1.23) and prior percutaneous coronary intervention (PCI) (OR: 1.19, 95% CI: 1.16-1.22). Patients admitted to a cardiac ward were more likely to receive optimal pharmacotherapy with statin (85% vs. 81%, P < 0.001) and dual antiplatelet therapy (DAPT) (91% vs. 88%, P < 0.001) on discharge, undergo invasive coronary angiography (78% vs. 59%, P < 0.001), and receive revascularisation in the form of PCI (52% vs. 36%, P < 0.001). Following multivariable logistic regression, the odds of inhospital all-cause mortality (OR: 0.75, 95% CI: 0.70-0.81) and major adverse cardiovascular events (MACE) (OR: 0.84, 95% CI: 0.78-0.91) were lower in patients admitted to a cardiac ward. CONCLUSION: Patients with NSTEMI admitted to a cardiac ward on admission were more likely to receive guideline directed management and had better clinical outcomes.
Authors: Mohamed O Mohamed; Muhammad Rashid; Adam Timmis; Sarah Clarke; Claire Lawson; Erin D Michos; Chun Shing Kwok; Mark De Belder; Marco Valgimigli; Mamas A Mamas Journal: Int J Cardiol Date: 2020-12-31 Impact factor: 4.164
Authors: Elizabeth H Bradley; Jeph Herrin; Yongfei Wang; Robert L McNamara; Tashonna R Webster; David J Magid; Martha Blaney; Eric D Peterson; John G Canto; Charles V Pollack; Harlan M Krumholz Journal: JAMA Date: 2004-10-06 Impact factor: 56.272
Authors: Saadiq M Moledina; Ahmad Shoaib; Clive Weston; Suleman Aktaa; Harriette G C Van Spall; Aliya Kassam; Evangelos Kontopantelis; Shrilla Banerjee; Muhammad Rashid; Chris P Gale; Mamas A Mamas Journal: Eur Heart J Qual Care Clin Outcomes Date: 2022-08-17
Authors: Saadiq M Moledina; Ahmad Shoaib; Michelle M Graham; Giuseppe Biondi-Zoccai; Harriette G C Van Spall; Evangelos Kontopantelis; Muhammad Rashid; Suleman Aktaa; Chris P Gale; Clive Weston; Mamas A Mamas Journal: Eur Heart J Qual Care Clin Outcomes Date: 2022-08-17
Authors: Jessica Potts; Alex Sirker; Sara C Martinez; Martha Gulati; Mirvat Alasnag; Muhammad Rashid; Chun Shing Kwok; Joie Ensor; Danielle L Burke; Richard D Riley; Lene Holmvang; Mamas A Mamas Journal: PLoS One Date: 2018-09-04 Impact factor: 3.240